基于倾向性评分匹配评估血清淀粉样蛋白A和白细胞介素6在手足口病中表达的临床意义

Clinical significance of serum amyloid protein A and interleukin-6 expression in hand,foot and mouth disease on the basis of propensity score matching

目的探讨血清淀粉样蛋白A(SAA)、白细胞介素6(IL-6)在不同类型手足口病(HFMD)中的表达情况。方法随机选择安徽省儿童医院2017年1月—2020年11月间收治的HFMD患儿216例作为观察对象,其中普通型HFMD患儿145例,重症HFMD患儿71例。采用倾向性评分匹配(PSM)方法进行1∶1匹配,匹配变量包括年龄、性别、病程、入院后采血时间、是否伴有咳嗽流涕、食欲不振等临床表现。用逆转录聚合酶链反应检测患者粪便中肠道病毒71(EV-A71)RNA,观察EV-A71在HFMD患儿中的分布。观察不同类型HFMD患儿静脉血SAA、IL-6表达的差异。结果重症型HFMD、普通型HFMD患者SAA、IL-6表达分别为[(162.50±11.23)mg/L vs.(10.28±2.06)mg/L;(49.96±6.85)pg/mL vs.(23.11±4.98)pg/mL],重症HFMD组患儿血清SAA、IL-6表达水平均高于普通型HFMD(均P<0.01)。重症型HFMD组中EV-A71阳性比例明显高于普通型组(χ^(2)=9.100,P=0.003)。重症型、普通型HFMD组中EV-A71阳性患儿的IL-6、SAA表达水平均显著高于EV-A71阴性患儿(均P<0.01)。EV-A71阳性、EV-A71阴性HFMD患儿SAA、IL-6表达分别为[(93.65±6.71)mg/L vs.(80.40±5.83)mg/L、(45.57±5.88)pg/mL vs.(28.37±3.15)pg/mL],EV-A71阳性HFMD组患儿血清SAA、IL-6表达水平均高于EV-A71阴性HFMD组(均P<0.001)。结论SAA、IL-6参与了HFMD的发病过程,并且和HFMD分型、EV-A71表达密切相关。

Objective To investigate the expression of serum amyloid A(SAA)and interleukin-6(IL-6)in different types of hand,foot and mouth disease(HFMD).Methods A total of 216 children with HFMD admitted to Anhui Provincial Children’s Hospital from Jan.2017 to Nov.2020 were randomly selected as the observation objects,including 145 children with common HFMD and 71 children with severe HFMD.Propensity score matching method was used for 1∶1 matching.The matching variables included age,gender,course of disease,blood collection time after admission,cough,runny nose,loss of appetite and other clinical manifestations.The distribution of enterovirus 71(EV-A71)RNA in the faeces of HFMD patients was observed by reverse transcription polymerase chain reaction.The expression of SAA and IL-6 in venous blood of children with different types of HFMD were observed.Results The expression levels of SAA and IL-6 in patients with severe HFMD and common HFMD were(162.50±11.23)mg/L vs.(10.28±2.06)mg/L and(49.96±6.85)pg/mL vs.(23.11±4.98)pg/mL,respectively.The expression levels of SAA and IL-6 in the severe HFMD group were higher than those in the common HFMD group(all P<0.01).The positive rate of EV-A71 in the severe HFMD group was significantly higher than that in the normal HFMD group(χ^(2)=9.100,P=0.003).The expression levels of IL-6 and SAA in patients with EV-A71-positive HFMD were significantly higher than those in patients with EV-A71-negative HFMD in both groups(all P<0.01).The expression levels of SAA and IL-6 in the EV-A71-positive HFMD group and EV-A71-negative HFMD group were(93.65±6.71)mg/L vs.(80.40±5.83)mg/L and(45.57±5.88)pg/mL vs.(28.37±3.15)pg/mL,respectively.The expression levels of serum SAA and IL-6 in the EV-A71-positive HFMD group were higher than those in the EV-A71-negative HFMD group(all P<0.01).Conclusion SAA and IL-6 are involved in the pathogenesis of HFMD and closely related to HFMD typing and EV-A71 expression.