血清COR、ACTH、FT3、FT4与TSH在重症手足口病患儿中的变化及病情评估价值

Changes of the serum levels of COR,ACTH,FT3,FT4 and TSH in children with severe HFMD and their evaluation value

目的:探讨血清皮质醇(COR)、促肾上皮质激素(ACTH)、游离三碘甲状腺素原氨酸(FT3)、游离甲状腺素(FT4)与促甲状腺激素(TSH)在重症手足口病患儿中的变化及病情评估价值。方法:选取93例重症手足口病患儿,根据患儿病情和临床分期,分为甲、乙、丙3组。其中,甲组为2期,31例;乙组为3期,31例;丙组为4期,31例。3组患儿入院后次日均抽取清晨空腹静脉血,采用化学发光检测法测定患儿血清COR、ACTH、FT3、FT4及TSH的水平。结果:乙组和丙组TSH、FT3和FT4水平均显著低于甲组,并且丙组TSH、FT3和FT4水平均显著低于乙组(P<0.01)。3组患儿入院时白细胞数、C反应蛋白、血压恢复正常时间、发热持续时间、机械通气时间、住院时间及治愈率的比较差异均有统计学意义(P<0.05~P<0.01)。重症手足口病患儿临床分期与ACTH、COR水平呈现正相关关系(P<0.05),临床分期与TSH和FT4、FT3水平呈现负相关关系(P<0.05)。结论:对重症手足口病患儿而言,其血清COR和ACTH水平均随着患儿病情加重而升高,但FT3、FT4与TSH水平则随着患儿病情加重而降低。

Objective:To investigate the changes of serum levels of cortisol(COR),adrenocorticotropic hormone(ACTH),free triiodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating hormone(TSH)in children with severe hand,foot and mouth disease(HFMD),and their evaluation value.Methods:Ninety-three childrens with severe HFMD were divided into group A(31 cases with stage 2),group B(31 cases with stage 3)and group C(31 cases with 4 stage)according to the disease condition and clinical stage.The fasting venous blood in the early morning in three groups after two days of admission were extracted,and the serum levels of COR,ACTH,FT3,FT4 and TSH in three groups were measured using chemoluminescence detection.Results:The serum levels of TSH,FT3 and FT4 in group B and group C were significantly lower than those in group A,and the levels of TSH,FT3 and FT4 in group C were significantly lower than those in group B(P<0.01).The differences of the number of leukocytes,C-reactive protein,time of blood pressure returning to normal,duration of fever,time of mechanical ventilation,days of hospitalization and cure rate among three groups were statistically significant(P<0.05 to P<0.01).Among three groups,the clinical stage was positively correlated with the levels of ACTH and COR(P<0.05),and negatively correlated with levels of TSH,FT4 and FT3(P<0.05).Conclusions:With the exacerbation of HFMD,the serum levels of COR and ACTH increase,but the serum levels of FT3,FT4 and TSH decrease.