手足口病患儿血清FGF-21与GDF-15水平检测的临床诊疗应用研究

Research on the Application of Serum FGF-21 and GDF-15 in Clinical Diagnosis and Treatment of Children with Hand,Foot and Mouth Disease

目的探讨手足口病(hand,foot and mouth disease,HFMD)患儿血清成纤维细胞生长因子21(fibroblast growth factor 21,FGF-21)和生长分化因子15(growth differentiation factor 15,GDF-15)表达水平及临床价值。方法选取2018年5月~2022年5月徐州医科大学附属徐州儿童医院诊治的HFMD患儿80例为研究对象,分为普通型组和重症组,每组40例;以同期因腹股沟斜疝诊治且无基础疾病的30例患儿作为对照组。应用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清FGF-21和GDF-15水平。受试者工作特征(ROC)曲线分析两指标单独及联合检测对重症HFMD的诊断价值。结果重症组血清FGF-21,GDF-15,IL-6水平分别为101.96±25.15 pg/ml,702.95±123.38pg/ml和176.73±74.01pg/ml,高于普通型组(84.10±18.85pg/ml,515.78±115.96pg/ml,105.80±35.33pg/ml)和对照组(77.51±17.12 pg/ml,337.33±121.07pg/ml,81.43±16.53pg/ml),差异均有统计学意义(t=3.595,6.991,5.469;4.585,12.368,7.855,均P<0.001)。与对照组相比,普通型组血清GDF-15水平升高,差异有统计学意义(t=6.252,P<0.001)。治疗7天后,重症组和普通型组血清FGF-21,GDF-15水和IL-6平均低于治疗前,差异均有统计学意义(t=5.599,6.741,6.537;2.741,6.711,7.266,均P<0.05)。ROC分析显示,血清FGF-21,GDF-15诊断重症HFMD的曲线下面积(AUC)分别为0.723(95%CI:0.611~0.835),0.868(95%CI:0.792~0.944),敏感度分别为92.50%,87.50%,特异度分别为52.50%,72.50%;两者联合串联检测诊断重症HFMD的AUC为0.875(95%CI:0.791~0.959),其敏感度和特异度分别为80.00%,82.50%。结论重症HFMD患儿血清FGF-21,GDF-15水平升高,检测其表达水平对重症HFMD的诊断具有重要参考价值。

Objective To investigate the serum levels offibroblast growth factor 21(FGF-21)and growth differentiation factor 15(GDF-15)in children with hand,foot and mouth disease(HFMD)and their clinical significance.Methods 80 children with HFMD diagnosed and treated in Xuzhou Children’s Hospital of Xuzhou Medical University from May 2018 to May 2022 were selected and classified into severe group and common group,with 40 cases in each group.30 children with oblique inguinal hernia but no underlying disease during the same period were selected as control group.Serum FGF-21 and GDF-15 levels in each group were detected by enzyme-linked immunosorbent assay(ELISA).Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum FGF-21,GDF-15 and combined detection for severe HFMD.Results Serum FGF-21,GDF-15 and IL-6 levels in the severe HFMD group were 101.96±25.15 pg/ml,702.95±123.38pg/ml and 176.73±74.01pg/ml,respectively,higher than those in common group(84.10±18.85pg/ml,515.78±115.96 pg/ml,105.80±35.33pg/ml)and control group(77.51±17.12 pg/ml,337.33±121.07pg/ml,81.43±16.53pg/ml),and the differences were statistically significant(t=3.595,6.991,5.469;4.585,12.368,7.855,all P<0.001).Compared with the control group,the serum GDF-15 level in the common group was increased,and the difference was statistically significant(t=6.252,P<0.001).After 7 days of treatment,serum FGF-21,GDF-15 and IL-6 in severe and common groups were decreased,and the differences were statistically significant(t=5.599,6.741,6.537;2.741,6.711,7.266,all P<0.05).The ROC curve showed that the area under the curve(AUC)of serum FGF-21 and GDF-15 levels predicting severe HFMD were 0.723(95%CI:0.611~0.835)and 0.868(95%CI:0.792~0.944),sensitivity was 92.50%,87.50%,specificity was 52.50%,72.50%,respectively.The AUC of the two combined prediction in series of severe HFMD was 0.875(95%CI:0.791~0.959),and the sensitivity and specificity were 80.00%and 82.50%,respectively.Conclusion The levels of serum FGF-21 and GDF-15 in children with severe HFMD were significantly increased,and has important reference value for the diagnosis of severe HFMD.