EV71感染者儿茶酚胺水平的研究被引量：19

Detection of catecholamine in cases with EV71 infection

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摘要目的比较EV71感染所致的各期手足口病患儿血和尿去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DO)此3种儿茶酚胺(CA)类物质的水平,观察神经系统受累期进展至心肺功能衰竭期此3种CA的变化。方法收集2011年8月至12月首都医科大学附属北京地坛医院收治的手足口病患儿共106例,筛选EV71阳性者进行CA检测。将患者分为4组,即手足口出疹期(1期)患儿为A组;神经系统受累期(2期)患儿为B组,其中未使用糖皮质激素者为B1组,使用糖皮质激素者为B2组;心肺功能衰竭前期(3期)患儿为C组;心肺功能衰竭期(4期)患儿为D组。以同期于本院门诊体检健康儿童为对照组。结果与对照组相比,A～D组患儿体内CA水平均有不同程度的升高。C组患儿DO、NE和E水平较对照组显著升高(P均=0.000),C组患儿血浆3种CA水平较A、B1、B2组显著升高(P均=0.000);C组患儿尿液中3种CA水平较A、B1、B2组显著升高(P均=0.000)。C组患儿发病期3种CA水平较恢复期差异有统计学意义(P=0.003、0.002和0.005),而A组、B1组、B2组发病期仅DO与NE较恢复期显著升高(P均<0.05)。结论手足口病1期患儿存在神经系统受累的可能。对2期患儿进行CA检测,可以预警病情。3和4期的患儿血浆CA水平较1和2期显著升高,且DO会先于NE和E升高,病程进入4期后,NE与E亦显著升高。糖皮质激素治疗对进入2期患儿的CA水平并无显著影响。 Objective To investigate the alteration of three types of catecholamine （CA） secretion of norepinephrine （NE）, epinephrine （E） and dopamine （DO） in different phases especially in hand, foot and mouth disease （HFMD） with enterovirus 7 （EVT1） infection and at the stage of the disease developing from phase 2 to end-stage cardiopulmonary failure. Methods Total of 106 patients with HFMD treated in Beijing Ditan Hospital, Capital Medical University during August to December 2011 were selected. The levels of CA in patients with EV71 positive were detected. HFMD rash cases （phase 1） were divided into group A, the nervous system involvement cases （phase 2） into group B, the prophase cases of cardiopulmonary failure （phase 3） into group C, heart and lung cardiopulmonary failure （phase 4） patients into group D. Group B includes group B 1 （without glucocorticoids） and group B2 （used glucocorticoids）. The control group were healthy children in the same period in the hospital. Results Compared to the maximum value of the control group, there were different degrees of increase for CA levels in group A, B 1, B2 and C. The levels of dopamine （DO）, norepinephrine （NE） and epinephrine （E） of group C during onset period had significant differences compared with the control group （P = 0.000）. There were significant differences between group C and group A, B1, B2 in DO levels of plasma and in urine （P = 0.000） during onset period. The plasma CA levels between onset period and convalescence were compared in group C, and there were significant differences （P = 0.003, 0.002, 0.005）. While only DO and NE were found significantly different in group A, group B1 and group B2 （P 〈 0.05）. Conclusions Partial patients might have neurological involvement during phase 1. The levels of CA during phase 1 and 2 might provide the early-warning. The levels of CA significantly increased after phase 3 and 4, while DO increased firstly, and NE and E increased subsequently after phase 4. Glucocorticoids therapy has no influence on the levels of CA of children with HFMD in nerve system involvement stage.