肠道病毒71型和柯萨奇病毒A组16型感染手足口病患儿血清基质金属蛋白酶-9、白细胞介素-1β、白细胞介素-10水平变化及临床意义

Changes of serum matrix metalloproteinase-9,interleukin-1βand interleukin-10 levels of children with hand-foot and mouth disease infected with enterovirus 71 and coxsackie virus A 16 and clinical significance

目的探讨肠道病毒71型(EV71)和柯萨奇病毒A组16型(CA16)感染手足口病(HFMD)患儿血清基质金属蛋白酶-9(MMP-9)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)水平变化及临床意义。方法选择2017年4月至2019年4月郑州大学附属儿童医院收治的HFMD患儿72例为研究对象,根据感染的病毒类型将患儿分为EV71组(n=32)和CA16组(n=40),另选择同期入院体检的健康儿童30例为对照组。记录EV71组和CA16组患儿入院前7 d内的病程、热程并计算临床症状发生率;入院第2天,检测3组患儿血清MMP-9、IL-1β及IL-10水平;采用Spearman对EV71组和CA16组患儿血清MMP-9、IL-1β及IL-10水平与病情程度进行相关性分析。结果EV71组患儿病程、热程显著长于CA16组(P<0.05)。EV71组和CA16组患儿的手足部出疹发生率比较差异无统计学意义(χ^(2)=0.981,P>0.05);EV71组患儿嗜睡、易惊、肢体抖动发生率显著低于CA16组(χ^(2)=5.113、4.194、4.500,P<0.05),咳嗽、惊厥、呕吐、肌肉挛缩发生率显著高于CA16组(χ^(2)=8.937、4.800、8.733、5.946,P<0.05)。EV71组和CA16组患儿血清MMP-9、IL-1β及IL-10水平显著高于对照组(P<0.05);EV71组患儿血清MMP-9、IL-1β及IL-10水平显著高于CA16组(P<0.05)。EV71组和CA16组重度患儿血清MMP-9、IL-1β及IL-10水平显著高于轻度患儿(P<0.05);CA16组轻度患儿血清MMP-9水平显著低于EV71组轻度患儿(P<0.05);CA16组重度患儿血清MMP-9水平显著低于EV71组重度患儿(P<0.05);2组轻度和重度患儿的血清IL-1β、IL-10水平比较差异无统计学意义(P>0.05)。EV71组患儿血清MMP-9、IL-1β、IL-10水平与病情程度呈正相关(r=0.345、0.412、0.309,P<0.05);CA16组患儿血清MMP-9、IL-1β与病情程度呈正相关(r=0.405、0.367,P<0.05),血清IL-10水平与病情程度无明显相关性(r=0.135,P>0.05)。结论HFMD患儿尤其是EV17感染患儿的血清MMP-9、IL-1β、IL-10水平显著升高,且MMP-9、IL-1β与患儿病情程度呈正相关。

Objective To explore the changes of serum matrix metalloproteinase-9(MMP-9),interleukin-1β(IL-1β)and interleukin-10(IL-10)levels of children with hand-food and mouse disease(HFMD)infected with enterovirus 71(EV71)and coxsackie virus A 16(CA16)and clinical significance.Methods A total of 72 children with HFMD who were admitted to the Children′s Hospital of Zhengzhou University from April 2017 to April 2019 were selected as research objects.The children were divided into EV71 group(n=32)and CA16 group(n=40)according to the type of virus infection.Another 30 healthy children who received health examination in the hospital during the same period were selected as the control group.The disease course and heat course of the children in the EV71 group and the CA16 group within 7 days before admission were recorded and the incidence of clinical symptoms were calculated;on the second day of admission,the serum MMP-9,IL-1βand IL-10 levels of the children in the three groups were detected;the correlation between serum MMP-9,IL-1β,IL-10 levels and the severity of the disease of children in the EV71 group and CA16 group was analyzed by Spearman.Results The disease course and heat course of the children in the EV71 group were significantly longer than those in the CA16 group(P<0.05).There was no significant difference in the incidence of hand and foot rashes between the EV71 group and the CA16 group(χ^(2)=0.981,P>0.05);the incidence of lethargy,susceptibility and limb jitter of the children in the EV71 group were significantly lower than those in the CA16 group(χ^(2)=5.113,4.194,4.500;P<0.05);the incidences of cough,convulsions,vomiting and muscle contracture were significantly higher than those in the CA16 group(χ^(2)=8.937,4.800,8.733,5.946;P<0.05).The levels of serum MMP-9,IL-1βand IL-10 of the children in the EV71 group and CA16 group were significantly higher than those in the control group(P<0.05);the levels of serum MMP-9,IL-1βand IL-10 of the children in the EV71 group were significantly higher than those in the CA16 group(P<0.05).The levels of serum MMP-9,IL-1βand IL-10 of severe children were significantly higher than those of mild children in the EV71 and CA16 groups(P<0.05);the level of serum MMP-9 of mild children in the CA16 group was significantly lower than that of mild children in the EV71 group(P<0.05);the level of serum MMP-9 of severe children in the CA16 group was significantly lower than that of severe children in the EV71 group(P<0.05);there was no significant difference in serum IL-1βand IL-10 levels of mild and severe children between the two groups(P>0.05).The serum MMP-9,IL-1β,IL-10 levels of children in the EV71 group were positively correlated with the severity of the disease(r=0.345,0.412,0.309;P<0.05);the serum MMP-9 and IL-1βlevels of children in the CA16 group were positively correlated with the severity of the disease(r=0.405,0.367;P<0.05);there was no significant correlation between the level of serum IL-10 and the severity of the disease of children in the CA16 group(r=0.135,P>0.05).Conclusion The levels of serum MMP-9,IL-1βand IL-10 of children with HFMD are significantly increased,especially in those infected with EV71,MMP-9 and IL-1βare positively correlated with the severity of the disease in children.