血清COR、ACTH及hs-cTnT水平评估手足口病病情及预后的实用价值

Practical value of serum COR,ACTH and hs-cTnT levels in evaluating the condition and prognosis of hand-foot-mouth disease

目的分析血清皮质醇(cortisol,COR)、促甲肾上腺素(Norepinephrine,ACTH)及高敏肌钙蛋白(high sensitivity troponin,hs-cTnT)水平,探讨这3项数值评估手足口病(hand-foot-mouth disease,HFMD)病情及预后的临床价值。方法选择某院收治的HFMD患者150例为观察组,并选择同期于该院查体的儿童30例为对照组。根据病情严重程度分为轻中症组、重症组及危重症组,根据预后情况分为预后良好组及预后不良组。采集患者空腹静脉血,检测COR、ACTH、hs-cTnT、C反应蛋白(C-reactive protein,CRP)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、白细胞水平。采用Pearson线性相关分析各因子水平变化的相关性。采用多因素Logistic回归分析HFMD患者病情的影响因素,采用ROC曲线分析COR、ACTH及hs-cTnT水平评估HFMD病情及预后的价值。结果3组HFMD患者的COR、ACTH及hs-cTnT水平明显高于对照组,且随患者病情的加重而升高,差异有统计学意义(F=255.960、121.510、115.000,P<0.05)。COR与ACTH、hs-cTnT呈明显正相关(r=0.516、0.487,P<0.05),ACTH与hs-cTnT呈明显正相关(r=0.619,P<0.05)。采用多因素Logistic回归分析得知,呼吸>40次/min、血糖>9 mmol/L、COR>190μg/L、ACTH>70 ng/L、hs-cTnT>6 ng/L均是HFMD患者病情进展及预后不良的危险因素(OR=7.584、20.156、18.674、22.165、20.365,P<0.05)。ROC曲线分析得出,COR、ACTH、hs-cTnT评估HFMD病情的AUC分别为0.812、0.769、0.729,三者联合检测评估HFMD病情的AUC为0.895。预后不良组患者COR、ACTH及hs-cTnT水平明显高于预后良好组,差异有统计学意义(t=6.117、6.964、41.884,P<0.05)。ROC曲线分析得出,COR、ACTH、hs-cTnT评估HFMD预后的AUC分别为0.836、0.771、0.716,三者联合检测评估HFMD预后的AUC为0.886。结论血清hs-cTnT、COR及ACTH水平在HFMD患者中呈明显高表达,三者在评估HFMD病情及预后方面具有重要价值,其中三者联合评估的价值最高,可在临床中广泛应用。

Objective To analyze the level of serum cortisol(COR),norepinephrine(ACTH)and high sensitivity troponin(hs-cTnT),and to evaluate the clinical value of pathogenetic condition and prognosis of hand-foot-mouth disease(HFMD).Methods One hundred and fifty patients with HFMD in a hospital were enrolled in the observation group and 30 children examined in the hospital during the same period were enrolled in the control group,and the patients were divided into mild and moderate disease group,severe disease group and critical disease group based on the severity of the disease,and such patients were divided into the good prognosis group and poor prognosis group based on the prognosis.Fasting venous blood was collected to detect the levels of COR,ACTH,hs-cTnT,C-reactive protein(CRP),creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and leukocytes.Pearson linear correlation was used to analyze the correlation between the change in the level of factors.Multivariate logistic regression was used to analyze the factors of HFMD patients′conditions,and receiver operating characteristic(ROC)curve was used to analyze the level of COR,ACTH and hs-cTnT to evaluate the pathogenetic condition and prognosis of HFMD.Results The level of COR,ACTH and hs-cTnT of HFMD patients in the three groups was significantly higher than such indexes in the control group,and the level of COR,ACTH and hs-cTnT increased with the aggravation of patients′pathogenetic conditions,and with statistically significant difference(F=255.960,121.510,115.000,P<0.05).COR was positively correlated with ACTH and hs-cTnT(r=0.516,0.487,P<0.05),and ACTH was positively correlated with hs-cTnT(r=0.619,P<0.05).Multivariate logistic regression analysis showed that respiration>40 times/min,blood glucose>9 mmol/L,COR>190μg/L,ACTH>70 ng/L and hs-cTnT>6 ng/L were risk factors for disease progression and poor prognosis in patients with HFMD(OR=7.584,20.156,18.674,22.165,20.365,P<0.05).ROC curve analysis showed that AUC of COR,ACTH and hs-cTnT in evaluating HFMD pathogenetic conditions was 0.812,0.769 and 0.729 respectively,and AUC of combined detection of COR,ACTH and hs-cTnT was 0.895.The level of COR,ACTH and hs-cTnT in the poor prognosis group were significantly higher than such indexes in the good prognosis group,and the difference was statistically significant(t=6.117,6.964,41.884,P<0.05).ROC curve analysis showed that AUC of COR,ACTH and hs-cTnT in evaluating the prognosis of HFMD was 0.836,0.771 and 0.716 respectively,and AUC of combined detection COR,ACTH and hs-cTnT in evaluating the prognosis of HFMD was 0.886.Conclusion The level of serum hs-cTnT,COR and ACTH are significantly and highly expressed in patients with HFMD.The three indexes are of great value in evaluating pathogenetic conditions and prognosis of HFMD.The combination of such indexes deliver the highest value and can be widely used in clinic.