CAJ | 학술논문

目的探讨EV71感染的普通手足口病患儿和重症患儿的临床表现差异与甘露糖结合凝集素(MBL)血清水平、基因多态性的相关性.方法 2009年6月至2011年7月在无锡市儿童医院门诊及住院EV71感染的手足口病患儿作为研究对象,用ELISA方法测定普通病例组、重症病例组的急重期和恢复期、对照组的血清MBL水平,同时对各组作MBL2基因测序,对比分析各组血清MBL,水平和MBL2基因6个常见位点变异频率.结果重症循环肺衰竭组MBL的血清水平在危重急重期时较普通病例、重症病例脑炎组、对照组有显著升高(P＜0.05)；而在恢复期时,重症病例循环肺衰竭组血清MBI.水平较急重期低约40％,有显著降低(P＜0.05).普通病例组、重症病例组、对照组的MBL2基因启动子区-550位点H/H野生型、+4P野生型、+230位点B/B纯合变异型的变异频率有显著不同(P值分别为0.006、0.043、0.028).缺少型基因的LYPB/LYPB和充足型基因的HYPA/HYPA频率在3组间差异有统计学意义(x2=7.17,P=0.028;x2 =8.55,P=0.014).重症病例组的缺少型基因LYPB/LYPB频率较对照组、普通病例组有显著升高,而充足型基因HYPA/HYPA频率较对照组、普通病例组有显著降低.结论 MBL2基因多态性导致的血清MBL蛋白水平低下与感染EV71的手足口病患儿病情轻重相关,可以作为患儿免疫状况和手足口病危险因素评估依据之一.
목적 탐토EV71감염적보통수족구병환인화중증환인적림상표현차이여감로당결합응집소(MBL)혈청수평、기인다태성적상관성.방법 2009년6월지2011년7월재무석시인동의원문진급주원EV71감염적수족구병환인작위연구대상,용ELISA방법측정보통병례조、중증병례조적급중기화회복기、대조조적혈청MBL수평,동시대각조작MBL2기인측서,대비분석각조혈청MBL,수평화MBL2기인6개상견위점변이빈솔.결과 중증순배폐쇠갈조MBL적혈청수평재위중급중기시교보통병례、중증병례뇌염조、대조조유현저승고(P＜0.05)；이재회복기시,중증병례순배폐쇠갈조혈청MBI.수평교급중기저약40％,유현저강저(P＜0.05).보통병례조、중증병례조、대조조적MBL2기인계동자구-550위점H/H야생형、+4P야생형、+230위점B/B순합변이형적변이빈솔유현저불동(P치분별위0.006、0.043、0.028).결소형기인적LYPB/LYPB화충족형기인적HYPA/HYPA빈솔재3조간차이유통계학의의(x2=7.17,P=0.028;x2 =8.55,P=0.014).중증병례조적결소형기인LYPB/LYPB빈솔교대조조、보통병례조유현저승고,이충족형기인HYPA/HYPA빈솔교대조조、보통병례조유현저강저.결론 MBL2기인다태성도치적혈청MBL단백수평저하여감염EV71적수족구병환인병정경중상관,가이작위환인면역상황화수족구병위험인소평고의거지일.
Objective To explore the relationship between the genetic polymorphism and serum concentration of mannan binding lectin (MBL)and the clinical manifestation of the hand-foot-mouth disease (HFMD) children infection by human enterovirus 71 (HEV71).Methods One hundred and thirty-eight children diagnosed as HFMD infected by HEV71 (including 80 mild cases and 58 severe cases) and 40 healthy,symptom-free children were investigated.The concentrations of serum MBL were measured in 40 healthy controls,80 mild HFMD cases and 56 severe HFMD cases at both acute and convalescent phases by a sandwich enzyme immunoassay with a human MBL ELISA kit.And the genomic DNA of all cases were extracted from blood according to standard phenol-chloroform procedure.Six SNPs in the MBL gene(-550G/C,-221G/C and +4C/T of the promoter,CGT52TGT,GGC54GAC,and GGA57GAA of the exon 1) were analyzed by a sequencing-based typing method.Results The MBL serum level of the severe HFMD circulatory respiratory failure group in acute phase was significantly increased compared with severe HFMD encephalitis group,the mild cases and the control,but in the convalescence phase it significantly decreased compared with them.The frequencis of type B/B mutation (+230 of the exon 1),type P/P mutation (+4C/T of the promoter),and type H/H mutation (-550G/C of the promoter) were a significant difference among mild group,severe group and the control(P=0.006,0.043,0.028,respectively).The frequencies of LYPB/LYPB genotype and HYPA/HYPA genotype were a significant difference among mild group,severe groupand the control (P=0.028,0.014,respectively).Conclusion Low MBL protein level as a result genetic polymorphism seems to be correlative with clinical manifestation of HFMD disease.The MBL gene mutation and low MBI.protein level may be used as one of the evaluation method of HFMD severeity.