神经元特异性烯醇化酶对手足口病重症病例诊断的临床意义

目的探讨手足口病(hand foot and mouth disease,HFMD)患儿的血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平对重症病例诊断的临床意义。方法收集2011年4月—2012年11月在本院儿内科治疗的320例HFMD患儿的临床资料,按临床表现分为轻症组(235例)和重症组(85例);按血清EV71抗体检测结果分为阳性组(89例)和阴性组(231例)。同时以在本院保健科体检的75名健康儿童为对照组,应用电化学发光法测定血清NSE水平。比较分析HFMD组和对照组、EV71抗体阳性组和阴性组、轻症组和重症组、HFMD并发颅内感染发病期和恢复期的NSE水平。结果血清NSE水平比较,HFMD组高于对照组;EV71抗体阳性组明显高于阴性组;重症组明显高于轻症组;重症颅内感染患儿发病期高于恢复期(P均0.05)。结论 HFMD患儿血清NSE水平升高,尤以EV71抗体阳性组最为明显。NSE水平越高,病情相对越重。NSE水平不仅是反应HFMD病程的可靠指标,也是判断病情加重趋势的有效指标。

Clinical significance of measuring neuron-specific enolase in early diagnosis of severe hand,foot and mouth disease

Objective To evaluate clinical significance of the level of neuron-specific enolase （NSE） in the diagnosis of child-ren with severe hand, foot and mouth disease （HFMD）. Methods The clinical data of 320 HFMD patients treated in the department of pediatrics of our hospital from Apr. 2011 to Nov. 2012 were collected. The patients were divided into a mild group （n=235） and a severe group （n=85） according to clinical manifestations, and an enterovirus （EV） 71 antibody positive group （n=89） and an EV71 anti-body negative group （n=231） according to the detection of antibodies against EV71. Seventy-five healthy children receiving physical examination in health care department of our hospital were selected as a control group. Chemiluminescence methods were used to detect serum NSE level in different groups, and the serum NSE level was compared between the HFMD group and the control group, between the EV71 antibody positive group and the EV71 antibody negative group, between the mild group and the severe group, and between the onset phase and the recovery phase of HFMD complicated by intracranial infection. Results Serum NSE level in the HFMD group was significantly higher than that in the control group, that in the EV71 antibody positive group was significantly high-er than that in the EV71 antibody negative group, that in the severe group was significantly higher than that in the mild group, and that in the onset phase of HFMD complicated by intracranial infection was significantly higher than that in the recovery phase （ P〈0.05）. Conclusions The serum NSE level in HFMD children is significantly higher, especially in the EV71 antibody positive child-ren. The higher the serum NSE level, the severer the condition. Serum NSE level is not only a reliable indicator reflecting the disease course of HFMD, but also an effective indicator predicting the severity of HFMD.