SAA、PCT 及WBC 对肠道病毒71 型感染 手足口病患儿的诊断价值

Diagnostic value of SAA, PCT and WBC in children with handfoot- and-mouth disease caused by enterovirus 71

摘要:

目的 分析肠道病毒71 型感染手足口病（HFMD）患儿的血清淀粉样蛋白A（SAA）、血清降钙 素原（PCT）和白细胞计数（WBC）水平，比较上述指标与患儿肌酸激酶（CK）、肌酸激酶同工酶（CKMB）、 乳酸脱氢酶（LDH）的相关性，探讨其对肠道病毒71 型感染HFMD 患儿的诊断价值。方法 选取2018 年 10 月—2019 年10 月中国人民解放军总医院收治的60 例肠道病毒71 型感染HFMD 患儿作为研究对象，分析 其基本资料和临床感染特征及表现。按照病情分为重症组和普通组，并选取30 例健康体检儿童作为对照组。 比较各组SAA、PCT、WBC，检测各组CK、CKMB、LDH 变化并与上述指标进行相关性分析。结果 普 通组和重症组SAA、PCT、WBC 高于对照组（P <0.05）；重症组SAA、PCT 高于普通组（P <0.05）。重症 组与对照组的SAA、PCT、WBC 的曲线下面积（AUC）分别为0.993（95% CI ：0.976，1.000）、0.995（95% CI ：0.982，1.000）和0.939（95% CI ：0.868，1.000）；重症组与普通组的SAA、PCT、WBC 的AUC 分别 为0.913（95% CI ：0.796，1.000）、0.911（95% CI ：0.793，1.000） 和0.756（95% CI ：0.607，0.906）。重症 组CK、CKMB、LDH 高于普通组和对照组；普通组CK、LDH 高于对照组。经相关性分析，CK 与SAA、 PCT、WBC 呈正相关（r s =0.565、0.759 和0.401，均P <0.05）；CKMB 与SAA、PCT、WBC 呈正相关（r s =0.416、 0.359 和0.315，均P <0.05）；LDH 与SAA、PCT、WBC 呈正相关（r s =0.550、0.358 和0.354，均P <0.05）。 结论 SAA、PCT、WBC 对肠道病毒71 型感染HFMD 病情有一定诊断价值，与CK、CKMB、LDH 共同检 测在预示肠道病毒71 型感染的HFMD 患儿由轻症转为重症方面具有指导意义。

Abstract:

Objective To analyze the levels of serum amyloid A (SAA), serum procalcitonin (PCT) and white blood cell (WBC) in children with hand-foot-and-mouth disease (HFMD) caused by enterovirus 71. To compare the correlation between the above indexes and creatine kinase (CK), creatine kinase MB isoenzyme (CKMB) and lactate dehydrogenase (LDH). To explore the diagnostic value of SAA, PCT and WBC in children with HFMD caused by enterovirus 71. Methods Sixty children with HFMD caused by enterovirus 71 in our hospital from October 2018 to October 2019 were selected. The demographic data and clinical characteristics and manifestations of the infection were analyzed. According to the clinical symptoms, the patients were divided into severe group and mild group, and 30 healthy children were selected as the control group. The average levels of SAA, PCT and WBC in each group were compared, and the changes of CK, CKMB and LDH in each group were detected. The correlation between the two sets of indicators was analyzed. Results The HFMD children with mild enterovirus 71 infection were mainly characterized by fever and rash, in which the fever lasted for more than 72 hours (56.66%), and the rash was mainly distributed in the hand, foot, mouth or hip (86.68%). HFMD children with severe enterovirus 71 infection had a variety of neurological and respiratory symptoms and cardio-pulmonary and cerebral complications. The main neurological symptoms were lethargy (83.33%), nausea and vomiting (70.00%) and clonic convulsions (60.00%). Respiratory symptoms were characterized by increased respiratory rate (53.33%), and complications were mainly myocardial injury (33.33%). There were significant differences in SAA (F =88.849, P < 0.05), PCT (F =94.396, P < 0.05) and WBC (F =24.943, P < 0.05) among the three groups. The values of SAA, PCT and WBC in children with HFMD were significantly higher than those in healthy children in control group (P < 0. 05). Besides, SAA and PCT in children with severe enterovirus 71 infection were also significantly higher than those in children with mild infection (P < 0. 05). The area under ROC curve of SAA, PCT, and WBC was respectively 0.993 (95% CI: 0.976, 1.000), 0.995 (95% CI: 0.982, 1.000) and 0.939 (95% CI: 0.868, 1.000) in the severe group compared with control group, while that was 0.913 (95% CI: 0.796, 1.000), 0.911 (95% CI: 0.793, 1.000) and 0.756 (95% CI: 0.607, 0.906) separately in the severe group compared with mild group. There were significant differences in CK (F =2974.874, P < 0.05), CKMB (F =20.057, P < 0.05) and LDH (F =77.231, P < 0.05) among the three groups. The values of CK, CKMB and LDH in HFMD children with severe enterovirus 71 infection were significantly higher than those in children with mild infection and healthy children (P < 0. 05). There was a significant positive correlation between CK and SAA (rs =0.565, P < 0.001), PCT (rs =0.795, P < 0.001), WBC (rs =0.401, P = 0.010), CKMB and SAA (rs =0.416, P = 0.008), PCT (rs =0.359, P = 0.023) and WBC (rs =0.315, P = 0.048), as well as LDH and SAA (rs =0.550, P < 0.001), PCT (rs =0.358, P = 0.023) and WBC (rs =0.354, P = 0.025). Conclusions SAA, PCT and WBC are of certain value in the diagnosis of HFMD caused by enterovirus 71, and the detection together with the CK, CKMB and LDH plays an essential role in predicting the condition of HFMD changing from mild to severe.