重型手足口病患儿外周血及脑脊液SAA和NYP表达及与脑损伤关系

Expression of SAA and NYP in peripheral blood and cerebrospinal fluid in children with severe hand-foot-mouth disease and their relationship with brain injury

目的探讨重型手足口病患儿外周血及脑脊液淀粉样蛋白A(SAA)、神经肽Y(NYP)表达及与脑损伤关系。方法选取2018年12月-2019年12月遵义市第一人民医院79例重型手足口病患儿作为研究对象,根据有无脑损伤分为脑损伤组(n=31)和无脑损伤组(n=48),统计两组外周血、脑脊液SAA、NYP表达、脑干反应阈值,Spearman分析两者间及与脑损伤相关性,绘制受试者工作曲线(ROC)分析上述指标预测重型手足口病脑损伤价值。结果脑损伤组外周血、脑脊液SAA、NYP水平及脑干反应阈值高于无脑损伤组(P<0.05);脑干反应阈值与外周血、脑脊液SAA、NYP水平呈正相关(P<0.05);重型手足口病患儿脑损伤与外周血、脑脊液SAA、NYP呈正相关(P<0.05);ROC曲线显示,脑脊液SAA预测脑损伤价值的AUC>脑脊液NYP>外周血NYP>外周血SAA,当其临界值为860.16 mg/L时,特异度及敏感度分别为61.29%、87.50%。结论重型手足口病脑损伤患儿外周血及脑脊液SAA、NYP呈异常高表达状态,且各指标对脑损伤均有一定预测价值,以脑脊液预测价值更优。

OBJECTIVE To investigate the expression of serum amyloid A(SAA)and neuropeptide Y(NYP)in peripheral blood and cerebrospinal fluid of children with severe hand-foot-mouth disease and their relationship with brain injury.METHODS From Dec 2018 to Dec 2019,79 children with severe hand-foot-mouth disease in the First People’s Hospital of Zunyi were recruited as the research subjects.They were divided into the brain injury group(n=31)and no brain injury group(n=48)according to the presence or absence of brain injury.The levels of SAA and NYP expression in peripheral blood and cerebrospinal fluid and brainstem response threshold were detected between two groups.Spearman was used to analyze the correlation between the SAA and NYP levels and brain injury.The receiver operating curve(ROC)was drawn to analyze the above indexes’prediction value of brain injury in severe hand-foot-mouth disease.RESULTS SAA and NYP levels in the peripheral blood and cerebrospinal fluid and brainstem response threshold in the brain injury group were significantly higher than those in the no brain injury group(P<0.05).The brainstem response threshold was positively correlated with the levels of SAA and NYP in peripheral blood and cerebrospinal fluid(P<0.05);brain injury in children with severe hand-foot-mouth disease was positively correlated with SAA and NYP in peripheral blood and cerebrospinal fluid(P<0.05);the ROC curve showed that the value of AUCs in predicting the brain injury were cerebrospinal fluid SAA>cerebrospinal fluid NYP>peripheral blood NYP>peripheral blood SAA,and when the cut-off value of cerebrospinal fluid SAA was 860.16 g/L,the specificity and sensitivity were 61.29%and 87.50%respectively.CONCLUSION The peripheral blood and cerebrospinal fluid SAA and NYP in brain injury children with severe hand-foot-mouth disease show abnormally high expression,and each index has a certain predictive value for brain injury,and the predictive value of cerebrospinal fluid is better.