中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2015年
5期
355-359
,共5页
手足口病%肠道病毒感染%抗体
手足口病%腸道病毒感染%抗體
수족구병%장도병독감염%항체
Hand,foot and mouth disease%Enterovirus infections%Antibodies
目的 测定重症手足口病(HFMD)患儿脑脊液肠道病毒71 (EV71) IgM抗体水平,分析脑脊液EV71-IgM抗体、脑脊液常规和生化检查及其与临床资料关系,为EV71重症HFMD患儿实验室诊断提供新参考.方法 收集2014年3至6月杭州市儿童医院收治的实验室确诊为EV71型感染重症HFMD患儿294例的临床资料,其中危重型53例,重型241例;酶联免疫吸附方法测定脑脊液EV71-IgM,并进行脑脊液常规和生化检测,结合临床资料进行统计分析;选取同期住院确诊为其他肠道病毒型感染重症HFMD患儿41例做抗体对照检测.结果 294例实验室确诊EV71感染重症HFMD患儿脑脊液EV71-IgM抗体总阳性率为60.2％ (177/294),其中危重型阳性率62.3％ (33/53),重型阳性率59.8％(144/241),41例对照组脑脊液EV71-IgM抗体均阴性.脑脊液EV71-IgM抗体阳性组的年龄[(2.5±1.2)岁]小于阴性组[(2.9±1.1)岁],差异有统计学意义(t=2.595,P=0.010),且在脑脊液EV71-IgM抗体阳性组中,危重型患儿年龄[(1.9±0.7)岁]与重型患儿年龄[(2.6±1.2)岁]比较,差异有统计学意义(t =3.150,P=0.002).抗体阳性组脑脊液有核细胞计数及阳性率[105(56,180)×106/L; 97.7％ (173/177)]均高于抗体阴性组[62(30,150)× 106/L;83.8％(98/117)],两组比较差异均有统计学意义(Z=3.663,P=0.000;x2=19.089,P=0.000),抗体阳性组以单核细胞为主[(57±25)％],抗体阴性组细胞分类单核细胞与多核细胞比例相当[(50±26)％比(50±26)％],抗体阳性组与阴性组相比,差异有统计学意义(t=2.343,P=0.020).脑脊液抗体阳性患儿中,危重型患儿脑脊液有核细胞数＞ 100×106/L比例占69.7％(23/33),与重型患儿比例47.2％ (68/144)比较差异有统计学意义(x2=5.429,P=0.02);脑脊液蛋白质定量及阳性率抗体阳性组均高于阴性组,比较差异均有统计学意义(Z =2.158,P=0.031;x2=5.921,P=0.015).结论 脑脊液EV71-IgM抗体测定可成为重症HFMD患儿实验室检查的重要指标,EV71-IgM抗体结果与脑脊液有核细胞计数与分类及蛋白质浓度相关.脑脊液抗体阳性患儿,有核细胞计数越高,年龄越小,越容易向危重型发展.
目的 測定重癥手足口病(HFMD)患兒腦脊液腸道病毒71 (EV71) IgM抗體水平,分析腦脊液EV71-IgM抗體、腦脊液常規和生化檢查及其與臨床資料關繫,為EV71重癥HFMD患兒實驗室診斷提供新參攷.方法 收集2014年3至6月杭州市兒童醫院收治的實驗室確診為EV71型感染重癥HFMD患兒294例的臨床資料,其中危重型53例,重型241例;酶聯免疫吸附方法測定腦脊液EV71-IgM,併進行腦脊液常規和生化檢測,結閤臨床資料進行統計分析;選取同期住院確診為其他腸道病毒型感染重癥HFMD患兒41例做抗體對照檢測.結果 294例實驗室確診EV71感染重癥HFMD患兒腦脊液EV71-IgM抗體總暘性率為60.2％ (177/294),其中危重型暘性率62.3％ (33/53),重型暘性率59.8％(144/241),41例對照組腦脊液EV71-IgM抗體均陰性.腦脊液EV71-IgM抗體暘性組的年齡[(2.5±1.2)歲]小于陰性組[(2.9±1.1)歲],差異有統計學意義(t=2.595,P=0.010),且在腦脊液EV71-IgM抗體暘性組中,危重型患兒年齡[(1.9±0.7)歲]與重型患兒年齡[(2.6±1.2)歲]比較,差異有統計學意義(t =3.150,P=0.002).抗體暘性組腦脊液有覈細胞計數及暘性率[105(56,180)×106/L; 97.7％ (173/177)]均高于抗體陰性組[62(30,150)× 106/L;83.8％(98/117)],兩組比較差異均有統計學意義(Z=3.663,P=0.000;x2=19.089,P=0.000),抗體暘性組以單覈細胞為主[(57±25)％],抗體陰性組細胞分類單覈細胞與多覈細胞比例相噹[(50±26)％比(50±26)％],抗體暘性組與陰性組相比,差異有統計學意義(t=2.343,P=0.020).腦脊液抗體暘性患兒中,危重型患兒腦脊液有覈細胞數＞ 100×106/L比例佔69.7％(23/33),與重型患兒比例47.2％ (68/144)比較差異有統計學意義(x2=5.429,P=0.02);腦脊液蛋白質定量及暘性率抗體暘性組均高于陰性組,比較差異均有統計學意義(Z =2.158,P=0.031;x2=5.921,P=0.015).結論 腦脊液EV71-IgM抗體測定可成為重癥HFMD患兒實驗室檢查的重要指標,EV71-IgM抗體結果與腦脊液有覈細胞計數與分類及蛋白質濃度相關.腦脊液抗體暘性患兒,有覈細胞計數越高,年齡越小,越容易嚮危重型髮展.
목적 측정중증수족구병(HFMD)환인뇌척액장도병독71 (EV71) IgM항체수평,분석뇌척액EV71-IgM항체、뇌척액상규화생화검사급기여림상자료관계,위EV71중증HFMD환인실험실진단제공신삼고.방법 수집2014년3지6월항주시인동의원수치적실험실학진위EV71형감염중증HFMD환인294례적림상자료,기중위중형53례,중형241례;매련면역흡부방법측정뇌척액EV71-IgM,병진행뇌척액상규화생화검측,결합림상자료진행통계분석;선취동기주원학진위기타장도병독형감염중증HFMD환인41례주항체대조검측.결과 294례실험실학진EV71감염중증HFMD환인뇌척액EV71-IgM항체총양성솔위60.2％ (177/294),기중위중형양성솔62.3％ (33/53),중형양성솔59.8％(144/241),41례대조조뇌척액EV71-IgM항체균음성.뇌척액EV71-IgM항체양성조적년령[(2.5±1.2)세]소우음성조[(2.9±1.1)세],차이유통계학의의(t=2.595,P=0.010),차재뇌척액EV71-IgM항체양성조중,위중형환인년령[(1.9±0.7)세]여중형환인년령[(2.6±1.2)세]비교,차이유통계학의의(t =3.150,P=0.002).항체양성조뇌척액유핵세포계수급양성솔[105(56,180)×106/L; 97.7％ (173/177)]균고우항체음성조[62(30,150)× 106/L;83.8％(98/117)],량조비교차이균유통계학의의(Z=3.663,P=0.000;x2=19.089,P=0.000),항체양성조이단핵세포위주[(57±25)％],항체음성조세포분류단핵세포여다핵세포비례상당[(50±26)％비(50±26)％],항체양성조여음성조상비,차이유통계학의의(t=2.343,P=0.020).뇌척액항체양성환인중,위중형환인뇌척액유핵세포수＞ 100×106/L비례점69.7％(23/33),여중형환인비례47.2％ (68/144)비교차이유통계학의의(x2=5.429,P=0.02);뇌척액단백질정량급양성솔항체양성조균고우음성조,비교차이균유통계학의의(Z =2.158,P=0.031;x2=5.921,P=0.015).결론 뇌척액EV71-IgM항체측정가성위중증HFMD환인실험실검사적중요지표,EV71-IgM항체결과여뇌척액유핵세포계수여분류급단백질농도상관.뇌척액항체양성환인,유핵세포계수월고,년령월소,월용역향위중형발전.
Objective To detect the anti-enterovirus 71 (EV71) IgM level in cerebrospinal fluid (CSF) of children with severe hand,foot and mouth disease (HFMD) induced by EV71 and then analyze the relationships among the IgM antibody levels,CSF routine examination and patients' clinical features,and thus to evaluate the clinical significance of anti-EV71 IgM as a new indicator for early diagnosis of children with severe HFMD induced by EV71.Method A total of 294 laboratory-confirmed cases of children with severe HFMD infected with EV71 were enrolled into the research group from March 2014 to June 2014,consisting of 53 fatal cases and 241 severe cases,and their CSF samples underwent enzyme-linked immunosorbent assay (ELISA) for anti-EV71 IgM levels,CSF routine and biochemical tests.Forty-one cases of children with severe HFMD induced by other enteroviruses were collected as antibody-testing control group during the same period.Result In the research group,the total positive rate of anti-EV71 IgM in 294 CSF samples of children with severe HFMD infected by EV71 was 60.2％ (177/294) ; the positive rate of anti-EV71 IgM in the fatal HFMD subgroup was 62.3％ (33/53) ; the positive rate of anti-EV71 IgM in the severe HFMD subgroup was 59.8％ (144/241).In the control group,the results of CSF anti-EV71 IgM tests were all negative (0/41).In the research group,patients in antibody-positive subgroup(2.5 ± 1.2) years old were younger than those in antibody-negative subgroup (2.9 ± 1.1) years old (t =2.595,P =0.010).And within the antibody-positive subgroup,the patients ((1.9 ±0.7) years old) with fatal type disease were younger than those ((2.6 ± 1.2) years old) with severe type disease (t =3.150,P =0.002).The CSF nucleated cells count and positive rates(105(56,180) × 106/L;97.7％ (173/177)) in antibody-positive subgroup were higher than those (62(30,150) × 106/L;83.8％ (98/117)) in antibody-negative subgroup (Z =3.663,P =0.000 ; x2 =19.089,P =0.000).In antibody-positive subgroup,the percentage of monocytes (57 ± 25) ％ was higher than that of polykaryocytes (43 ± 25) ％.In antibody-negative subgroup,the percentage of monocytes (50 ± 26)％ was close to that of polykaryocytes (50 ± 26)％.In the antibody-positive subgroup,the ratio of the patients with nucleated cells count higher than 100 × 106/L in fatal type group and severe type group was 69.7％ (23/33) and 47.2％ (68/144) respectively (x2 =5.429,P =0.02).The CSF protein quantity and positive rates in antibody-positive subgroup were higher than those in antibody-negative subgroup (Z =2.158,P =0.031 ; x2 =5.921,P =0.015).Conclusion The anti-EV71 IgM levels in CSF can serve as an important indicator for early diagnosis of children with severe HFMD induced by EV71.And the anti-EV71 IgM levels in CSF correlated to the CSF nucleated cells count and classification and CSF protein quantity.In the antibody-positive subgroup,the higher the nucleated cell count or the younger the age,the higher the possibility of patients to develop into fatal cases.
