中华微生物学和免疫学杂志
中華微生物學和免疫學雜誌
중화미생물학화면역학잡지
CHINESE JOURNAL OF MICROBIOLOGY AND IMMUNOLOGY
2013年
9期
666-672
,共7页
林建生%彭维林%潘万贵%黎冉%傅清流%沈晓丽
林建生%彭維林%潘萬貴%黎冉%傅清流%瀋曉麗
림건생%팽유림%반만귀%려염%부청류%침효려
手足口病合并脑炎%血管内皮生长因子%血管细胞间黏附分子-1%病情进展%危险因素
手足口病閤併腦炎%血管內皮生長因子%血管細胞間黏附分子-1%病情進展%危險因素
수족구병합병뇌염%혈관내피생장인자%혈관세포간점부분자-1%병정진전%위험인소
Hand foot and mouth disease combined with encephalitis%Vascular endothelial growth factor%Vascular cell adhesion molecule-1%Disease progression%Risk factor
目的研究血管内皮生长因子（ vascular endothelial growth factor ，VEGF）和血管细胞间黏附分子-1（vascular intercellular adhesion molecule-1，VCAM-1）在手足口病（hand foot and mouth dis-ease，HFMD）合并脑炎患儿血清与脑脊液中的水平及变化规律，探讨VEGF和VCAM-1在手足口病合并脑炎中的意义及患儿手足口病合并脑炎疾病进展的危险因素。方法以92例手足口病患儿为研究对象，并将其分为A（手足口病无合并脑炎普通组）、B（手足口病合并脑炎重型组）、C（手足口病合并脑炎危重组）、D（手足口病合并脑炎恢复组）4组。采用双抗体夹心ELISA法检测血清及脑脊液VEGF与VCAM-1水平。采用多因素logistic回归对手足口病普通型与重型、重型与危重型之间具有统计学意义的项目进行手足口病合并脑炎病情进展危险因素分析。结果以SPSS16．0统计软件进行统计学处理，比较结果以P＜0．05为差异有统计学意义。结果血清与脑脊液VEGF、VCAM-1水平在A、B、C、D4组间相比较差异均有统计学意义，且 A组与B组、A组与C组、B组与D组、C组与D组之间血清与脑脊液VEGF、VCAM-1水平差异亦均有统计学意义，而A组与D组、B组与C组之间血清、脑脊液VEGF、VCAM-1比较差别均无统计学意义。此外手足口病普通型与重型之间具有统计学意义的项目还有热程、肢体抖动、脑脊液白细胞（ WBC）计数、脑脊液蛋白、EV71型IgM。重型与危重型之间具有统计学意义的项目有呼吸次数、心率、脑脊液WBC计数。经多因素logistic回归分析显示，手足口病无合并脑炎向合并脑炎重型进展的危险因素是肢体抖动、脑脊液蛋白、血清VEGF及VCAM-1，P值分别是0．071、0．019、0．020、0．025，OR值分别为147．629、26．572、5．958、6．345；手足口病合并脑炎重型向危重型进展危险因素是心率加快，P值是0．001，OR值为2．69。结论（1）手足口病合并脑炎患儿血清、脑脊液VEGF、VCAM-1均呈高浓度表达，可为手足口病是否合并脑炎的鉴别诊断的辅助指标，且两者均一定程度上反映了疾病的严重程度及预后；（2）肢体抖动、脑脊液蛋白、血清VEGF及VCAM-1有助于早期识别重型患儿，而心率加快则有助于早期识别危重患儿，早期及时治疗，防止病情恶化。
目的研究血管內皮生長因子（ vascular endothelial growth factor ，VEGF）和血管細胞間黏附分子-1（vascular intercellular adhesion molecule-1，VCAM-1）在手足口病（hand foot and mouth dis-ease，HFMD）閤併腦炎患兒血清與腦脊液中的水平及變化規律，探討VEGF和VCAM-1在手足口病閤併腦炎中的意義及患兒手足口病閤併腦炎疾病進展的危險因素。方法以92例手足口病患兒為研究對象，併將其分為A（手足口病無閤併腦炎普通組）、B（手足口病閤併腦炎重型組）、C（手足口病閤併腦炎危重組）、D（手足口病閤併腦炎恢複組）4組。採用雙抗體夾心ELISA法檢測血清及腦脊液VEGF與VCAM-1水平。採用多因素logistic迴歸對手足口病普通型與重型、重型與危重型之間具有統計學意義的項目進行手足口病閤併腦炎病情進展危險因素分析。結果以SPSS16．0統計軟件進行統計學處理，比較結果以P＜0．05為差異有統計學意義。結果血清與腦脊液VEGF、VCAM-1水平在A、B、C、D4組間相比較差異均有統計學意義，且 A組與B組、A組與C組、B組與D組、C組與D組之間血清與腦脊液VEGF、VCAM-1水平差異亦均有統計學意義，而A組與D組、B組與C組之間血清、腦脊液VEGF、VCAM-1比較差彆均無統計學意義。此外手足口病普通型與重型之間具有統計學意義的項目還有熱程、肢體抖動、腦脊液白細胞（ WBC）計數、腦脊液蛋白、EV71型IgM。重型與危重型之間具有統計學意義的項目有呼吸次數、心率、腦脊液WBC計數。經多因素logistic迴歸分析顯示，手足口病無閤併腦炎嚮閤併腦炎重型進展的危險因素是肢體抖動、腦脊液蛋白、血清VEGF及VCAM-1，P值分彆是0．071、0．019、0．020、0．025，OR值分彆為147．629、26．572、5．958、6．345；手足口病閤併腦炎重型嚮危重型進展危險因素是心率加快，P值是0．001，OR值為2．69。結論（1）手足口病閤併腦炎患兒血清、腦脊液VEGF、VCAM-1均呈高濃度錶達，可為手足口病是否閤併腦炎的鑒彆診斷的輔助指標，且兩者均一定程度上反映瞭疾病的嚴重程度及預後；（2）肢體抖動、腦脊液蛋白、血清VEGF及VCAM-1有助于早期識彆重型患兒，而心率加快則有助于早期識彆危重患兒，早期及時治療，防止病情噁化。
목적연구혈관내피생장인자（ vascular endothelial growth factor ，VEGF）화혈관세포간점부분자-1（vascular intercellular adhesion molecule-1，VCAM-1）재수족구병（hand foot and mouth dis-ease，HFMD）합병뇌염환인혈청여뇌척액중적수평급변화규률，탐토VEGF화VCAM-1재수족구병합병뇌염중적의의급환인수족구병합병뇌염질병진전적위험인소。방법이92례수족구병환인위연구대상，병장기분위A（수족구병무합병뇌염보통조）、B（수족구병합병뇌염중형조）、C（수족구병합병뇌염위중조）、D（수족구병합병뇌염회복조）4조。채용쌍항체협심ELISA법검측혈청급뇌척액VEGF여VCAM-1수평。채용다인소logistic회귀대수족구병보통형여중형、중형여위중형지간구유통계학의의적항목진행수족구병합병뇌염병정진전위험인소분석。결과이SPSS16．0통계연건진행통계학처리，비교결과이P＜0．05위차이유통계학의의。결과혈청여뇌척액VEGF、VCAM-1수평재A、B、C、D4조간상비교차이균유통계학의의，차 A조여B조、A조여C조、B조여D조、C조여D조지간혈청여뇌척액VEGF、VCAM-1수평차이역균유통계학의의，이A조여D조、B조여C조지간혈청、뇌척액VEGF、VCAM-1비교차별균무통계학의의。차외수족구병보통형여중형지간구유통계학의의적항목환유열정、지체두동、뇌척액백세포（ WBC）계수、뇌척액단백、EV71형IgM。중형여위중형지간구유통계학의의적항목유호흡차수、심솔、뇌척액WBC계수。경다인소logistic회귀분석현시，수족구병무합병뇌염향합병뇌염중형진전적위험인소시지체두동、뇌척액단백、혈청VEGF급VCAM-1，P치분별시0．071、0．019、0．020、0．025，OR치분별위147．629、26．572、5．958、6．345；수족구병합병뇌염중형향위중형진전위험인소시심솔가쾌，P치시0．001，OR치위2．69。결론（1）수족구병합병뇌염환인혈청、뇌척액VEGF、VCAM-1균정고농도표체，가위수족구병시부합병뇌염적감별진단적보조지표，차량자균일정정도상반영료질병적엄중정도급예후；（2）지체두동、뇌척액단백、혈청VEGF급VCAM-1유조우조기식별중형환인，이심솔가쾌칙유조우조기식별위중환인，조기급시치료，방지병정악화。
Objective To explore the risk factors in disease progression and the significance of vascular endothelial growth factor ( VEGF ) and vascular intercellular adhesion molecule-1 ( VCAM-1 ) in hand foot and mouth disease ( HFMD) combined with encephalitis .Methods Altogether 92 subjects with HFMD were enrolled in the study and were divided into four groups , including group A ( ordinary group with no complication ) , group B ( severe group with complication ) , group C ( critical group with complication ) , group D ( recovery group with complication ) .Concentrations of VEGF and VCAM-1 in serum and cerebro-spinal fluid were detected by double antibody sandwich ELISA method .Multiple factors logistic regression analysis was performed to analyze main risk factors in disease progression for two combinations , one for ordi-nary group and severe group , the other for severe group and critical group .The results were analyzed by SPSS16.0 statistical software.Results The concentration of VEGF and VCAM-1 in serum and cerebrospi-nal fluid had statistically significant differences among the four groups , but there was no significant difference between group A and group D , and between group B and group C .In addition , the statistically significant factors for prediction of disease progression were duration of fever , limb shaking, cerebrospinal fluid WBC , cerebrospinal fluid protein and EV 71 IgM between ordinary group and severe group , and cerebrospinal fluid WBC, respiratory rate and heart rate between severe group and critical group .The multiple factors logistic regression analysis revealed that limb shaking , cerebrospinal fluid protein , VEGF and VCAM-1 in serum were the main risk factors for disease progression from ordinary to severe (P=0.071, 0.019, 0.020, 0.025 and OR=147.629, 26.572, 5.958, 6.345).And increased heart rate indicated the progression from se-vere to critical with P value of 0.001 and OR value of 2.69.Conclusion (1) Compared with group A, VEGF and VCAM-1 in serum and cerebrospinal fluid were highly expressed in patients with HFMD combined with encephalitis .Therefore , VEGF and VCAM-1 could be used as diagnostic criteria for auxiliary diagnosis of encephalitis in patients with HFMD and reflect the severity and prognosis to a certain extent .( 2 ) Risk factors like limb shaking , cerebrospinal fluid protein , VEGF and VCAM-1 in serum would be helpful to early diagnosis of severe patients .Increased heart rate would be a significant factor for identification of patients with critical disease , according to which a timely treatment would be provided to prevent from worse .
