HMGB-1和NSE对肠道病毒A71感染的手足口病患儿病情预测价值

Detection significance of high mobility group protein-1 and neuronspecific enolase in enterovirus 71 infected children with hand,foot,and mouth disease

目的研究肠道病毒A71(EV71)引起的不同病情严重程度手足口病(HFMD)患儿外周血中神经元特异性烯醇化酶(NSE)及高迁移率族蛋白-1(HMGB-1)水平,分析两者对EV71感染HFMD病情的预测价值。方法将59例EV71感染的HFMD患儿作为HFMD组,另选择60例体检健康儿童作为对照组,HFMD组患儿根据其入院时病情严重程度分为普通型组(n=30)、重症重型组(n=22)及重症危重型组(n=7),比较HFMD组和对照组、不同严重程度HFMD组儿童间入院或体检时的血清HMGB-1、NSE、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平,采用Spearman法分析HFMD患儿学清NSE、HMGB-1水平与IL-6、TNF-α水平的相关性,采用受试者工作曲线(ROC)下面积(AUC)评估血清NSE、HMGB-1对HFMD病情的预测价值。结果HFMD组患儿血清HMGB-1、NSE、IL-6、TNF-α水平高于对照组(P<0.01),HFMD组患儿血清HMGB-1、NSE、IL-6、TNF-α水平比较,普通型组<重症重型组<重症危重型组(P<0.05);HFMD患儿血清NSE、HMGB-1与IL-6、TNF-α呈正相关(r=0.56、0.49、0.83、0.69,P<0.01);NSE、HMGB-1及两者联合对重症重型及重症危重型的AUC分别为0.74(95%CI为0.62~0.87)、0.92(95%CI为0.85~0.98)及0.92(95%CI为0.85~0.99)。结论EV71感染会引起HFMD患儿血清NSE及HMGB-1水平升高,并与病情严重程度及IL-6、TNF-α水平呈正相关,两者联合检测可作为预测HFMD病情的重要指标。

Objective To investigate the levels of neuron-specific enolase(NSE)and high-mobility group box-1 protein(HMGB-1)in peripheral blood of children with various degrees of hand,foot and mouth diseases(HFMD)caused by enterovirus 71(EV71)and to analyze the predictive value of the severity of HFMD.Methods Fifty-nine children with HFMD in our hospital were selected as subjects.According to the severity of their conditions on admission,the children were divided into normal type(n=30),severe type(n=22)and critical type(n=7).In addition,60 healthy children with physical examination in our hospital during the same period were selected as the control group.Serum levels of HMGB-1,NSE,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared among all the groups.The correlation between the levels of HMGB-1 and NSE and the levels of IL-6 and TNF-αwas analyzed.ROC analysis was used to determine the value of HMGB-1 and NSE in severe HFMD.Results Serum HMGB-1,NSE,IL-6,and TNF-αlevels in HFMD group were significantly higher than those in the control group,and the differences were statistically significant(P<0.01).Serum HMGB-1,NSE,IL-6,and TNF-αlevels were significantly different between HFMD normal,severe and critical groups(P<0.01).The levels of HFMD common HMGB-1,NSE,IL-6,and TNF-αwere significantly lower than those of the severe group.The levels of HMGB-1,NSE,IL-6,and TNF-αin the severe HFMD group were significantly lower than those in the critical group,with statistically significant difference(P<0.05).Serum NSE and HMGB-1 of HFMD children was significantly positively correlated with IL-6 and TNF-α(r=0.56,0.49,0.83,0.69;P<0.01).The AUC s under the curves of NSE,HMGB-1,and NSE combined with HMGB-1 HFMD in the severe and critical cases were 0.74(95%CI was 0.62-0.87),0.92(95%CI was 0.85-0.98)and 0.92(95%CI was 0.85-0.99),respectively.Conclusion NSE and HMGB-1 levels significantly increase in children with HFMD,and the more severe the disease,the higher the NSE and HMGB-1 levels are.NSE and HMGB-1 levels are positively correlated with the levels of inflammatory cytokines IL-6 and TNF-α.NSE and HMGB-1 can be used as important indicators to judge the severity of HFMD.