手足口病肠道病毒71感染患儿血、尿白三烯水平与病情的相关性分析

Correlation between the levels of leukotriene in serum, urine and disease severity in children with hand-foot-mouth disease infected with enterovirus 71

目的检测手足口病肠道病毒71(enterovirus 71,EV71)感染患儿中血清中白三烯B4(LTB4)水平和尿中白三烯E4(LTE4)水平,观察白三烯是否与病情的发生和发展相关。方法选取2015年1月至2016年10月确诊EV71感染手足口病的患儿90例为病例组,健康对照组选择30例健康查体儿童。依据临床表现,病例组分为3组,分别为普通病例组、重症重型病例组和重症危重型病例组。收集所有受试者外周血白细胞,随机血糖,脑脊液和头颅MRI的数据,检测血清LTB4、尿液中LTE4的浓度,随访病程中是否出现心肌损害、肺水肿、需要机械通气和遗留肢体迟缓性瘫痪。结果血清中LTB4与尿中LTE4的浓度在健康对照组和普通病例组差异无统计学意义(P>0.05),重症重型病例组和重症危重型病例组两者水平均升高,尤其是重症危重型病例更为显著,差异有统计学意义(P<0.05)。就诊时病情重的患儿更易出现脑脊液和头颅MRI异常、肢体迟缓性麻痹遗留、心肌损害、肺水肿和需要机械通气。结论血清LTB4、尿LTE4指标与手足口病EV71感染患儿病情相关,监测白三烯水平可能有利于早期判别和治疗重症患儿可能出现的器官损伤,早期发现和治疗可能病情进展出现生命危险的患儿。

Objective To detect the levels leukotriene B4 in serum and urine of children with hand-foot-mouth disease infected with enterovirus 71,and to explore the correlation of leukotriene and the pathogenesis and development of the disease.Methods Ninety children with hand-foot-mouth disease,who were diagnosed as EV71 infection in our hospital from January 2015 to October 2016,were enrolled as case group,at the same time,thirty healthy children were enrolled as control group.The patients were subdivided into common case group,severe case group and critical case group according to the clinical manifestations.The cilinical data including peripheral leukocytes,random blood glucose,cerebrospinal fluid and cranial mri were collected.Moreover,the levels of serum leukotriene B4 and urinary leukotriene E4 were detected.In addition,myocardial damage,pulmonary edema,mechanical ventilation and delayed limb paralysis were observed in follow-up.Results There were no significant differences in the levels of LTB4 in serum and urine of patients between control group and common case group(P>0.05).The levels of LTB4 and LTE4 were increased significantly in severe case group and critical case group,in which,those in critical case group were more significant(P<0.05).The children with severe disease were more likely to develop abnormal cerebrospinal fluid and cranial MRI,delayed limb paralysis myocardial damage,pulmonary edema and mechanical ventilation.Conclusion The serum leukotriene B4 and urinary leukotriene E4 are related to the disease condition of children with hand-foot-mouth disease infected enterovirus 71.Monitoring the level of leukotriene may be helpful for early identification of the disease and further treatment.