嗜铬粒蛋白A水平在预测重症手足口病并发神经源性肺水肿患儿预后中的意义

Serum chromogranin A(CGA)level in predicting the prognosis of severe hand,foot,and mouth disease complicated with neurogenic pulmonary edema

目的探讨嗜铬粒蛋白A(Chromogranin A,CGA)对预测并发神经源性肺水肿(Neurogenic pulmonary edema,NPE)的重症手足口病(Hand,foot,and mouth disease,HFMD)患儿预后的临床意义。方法选取2017年1月至2019年12月于郑州大学附属儿童医院确诊并住院治疗的符合入组标准的HFMD患儿162例,根据严重程度分为轻症组、重症无NPE组和重症并发NPE组,同时选取同期行常规体检的40名儿童为健康对照组。以住院28 d为预后观察截断点,将重症HFMD患儿分为生存组和死亡组。所有入组对象均在入院2 h内检测CGA、乳酸、血糖、白细胞、降钙素原(PCT)、白细胞介素-6(IL-6)和肌钙蛋白T(cTnT)。采用SPSS 23.0软件进行数据分析,采用受试者工作特征(ROC)曲线评估各指标对重症HFMD合并NPE的诊断效能。结果162例HFMD患儿中,轻症组88例,重症无NPE组46例,重症并发NPE组28例。重症并发NPE组入院2 h内外周血CGA、血糖、乳酸、IL-6和cTnT水平显著升高,与重症无NPE组、轻症组以及对照组比较差异均有统计学意义(H=61.554、79.031、86.994、36.477和75.021,P值均<0.05)。截至住院28 d,重症HFMD患儿生存组58例,死亡组16例。死亡组患儿外周血CGA、乳酸、血糖和IL-6水平明显高于生存组,差异均有统计学意义(Z=-6.094、-4.621、-4.283和-5.504,P值均<0.05)。外周血CGA识别重症HFMD并发NPE的ROC曲线下面积为0.890(95%CI:0.833~0.947),截断值为120.59μg/L时,对于合并NPE的重症HFMD诊断效能最高。结论外周血CGA可能与重症HFMD并发NPE的发生发展过程有关,其检测有助于早期识别重症HFMD并发NPE,可能作为预测重症HFMD预后的指标之一。

Objective To explore the clinical significance of serum Chromogranin A(CGA)level in predicting the prognosis of children with severe hand,foot,and mouth disease(HFMD)and complicating neurogenic pulmonary edema(NPE).Methods A total of 162 patients with HFMD admitted in our hospital from January 2017 to December 2019 were enrolled in the study;and 40 age-matched healthy children were selected as controls.According to the disease severity and complication the patients were divided into three groups:mild group(n=88),severe without NPE group(n=46)and severe with NPE group(n=28).In 72 severe HFMD patients 16 cases died(fatal group)and 56 cases survived(survival group)within 28 days of hospitalization.The serum CGA,LAC,GLU,WBC,PCT,IL-6,cTnT were measured in all subjects.SPSS 23.0 software was used for data analysis,and the receiver operating characteristic(ROC)curve was used to evaluate the various indicators for predicting the prognosis of severe HFMD combined with NPE.Results The serum CGA,GLU,LAC,IL-6 and cTnT levels in severe HFMD group with NPE significantly higher than those in the other three group(H=61.554,79.031,86.994,36.477,75.021,all P<0.05).The serum CGA,LAC,GLU and IL-6 levels in the fatal group were significantly higher than those in survival group(Z=-6.094,-4.621,-4.283,-5.504,all P<0.05).There was no significant difference in the levels of WBC,PCT and cTnT between the survival group and the fatal group(P>0.05).The area under the receiver operating curve(AUC)of serum CGA was 0.890(95%CI:0.833-0.947)for predicting the prognosis of patients and the best cut-off value was 120.59μg/L.Conclusion The detection of serum CGA levels may be beneficial for the early diagnosis of severe HFMD with NPE,and can be used as one of the predictors of death from severe HFMD.