血清神经特异性烯醇化酶与C反应蛋白对手足口病并发脑炎患儿的早期诊断价值

目的：分析手足口病（HFMD）患儿血清神经特异性烯醇化酶（NSE）与C反应蛋白（CRP）水平的变化，探讨其在H FM D并发脑炎中的早期诊断价值。方法以120例 H FM D患儿及50例健康儿童（健康对照组）为研究对象，并按临床表现将HFMD患儿分为普通HFMD组（70例）与HFMD并发脑炎组（50例），采用定量PCR法检测咽拭子肠道病毒71型（EV71），采用酶联免疫吸附试验检测NSE及CRP水平，同时检测白细胞（WBC）计数，并分析NSE与CRP的诊断价值。结果 HFMD并发脑炎组患儿血清NSE、CRP水平高于HFMD普通组及健康对照组，差异均有统计学意义（P＜0．05）；EV71阳性患儿NSE及CRP水平均高于EV71阴性患儿，差异均有统计学意义（P＜0．05），但WBC计数差异无统计学意义（P＞0．05）。血清NSE与CRP水平呈正相关（r＝0．43，P＜0．01）。NSE、CRP的受试者工作特征（ROC）曲线下面积（AUC）及其95％置信区间（CI）分别为0．893（0．833～0．952）、0．867（0．799～0．934），最佳工作点（OOP）分别为11．6 ng／mL、14．15 mg／L ，此时NSE、CRP诊断 HFMD并发脑炎的灵敏度分别为80．0％、86．0％，特异度分别为81．4％、78．6％；二者串联检测的诊断灵敏度与特异度分别为88．0％和85．7％，AUC及其95％ CI为0．927（0．845～0．969）。结论 HFMD并发脑炎患儿早期NSE及CRP水平明显升高，EV71阳性者更为显著，联合检测血清NSE及CRP水平可作为诊断HFMD并发脑炎的早期敏感指标。

Early diagnosis value of serum neuron-specific enolase and CRP in hand-foot-mouth disease complicating encephalitis

Objective To analyze the change of serum levels of neuron‐specific enolase (NSE) and C reactive protein (CRP) and their early diagnostic value in hand‐foot‐mouth disease (HFMD) complicating encephalitis .Methods One hundred and twenty cases of HFMD and 50 healthy children(healthy control group) served as the research subjects and the HFMD cases were divided into the common HFMD group (n=70) and HFMD complicating encephalitis group (n=50) according to the clinical manifesta‐tions .The enterovirus 71 (EV71) in throat swab was detected by quantitative PCR .The NSE and CRP levels were detected by en‐zyme linked immunosorbent assay (ELISA) ,and white blood cell (WBC) count was measured by hematology analyzer .The NSE and CRP levels were compared and their diagnostic values were analyzed .Results The serum NSE and CRP levels in the HFMD complicating encephalitis group were higher than those in the HFMD common group and control group ,the differences were statis‐tically significant (P< 0 .05) ,and which in the EV71 positive group were significantly higher than those in the EV71 negative group ,the differences were statistically significant (P<0 .05) ,but WBC count had no statistically significant difference (P>0 .05) . The serum NSE level was positively correlated with the CRP level (r=0 .43 ,P<0 .01) .The area under ROC curves (AUC) and 95% CI of NSE and CRP were 0 .893(95% CI:0 .833 -0 .952) and 0 .867(95% CI:0 .799 -0 .934) ,the optimal operating points (OOP) were 11 .6 ng/mL and 14 .15 mg/L respectively ,the sensitivity and specificity of NSE and CRP for diagnosing HFMD com‐plicating encephalitis were 80 .0% ,86 .00% and 81 .4% ,78 .6% respectively ,while which of their combined detection were 88 .0%and 85 .7% ,AUC and 95% CI was 0 .927(95% CI:0 .845-0 .969) .Conclusion The NSE and CRP levels in children patients with early HFMD complicating encephalitis are significantly increased ,especially which in the patients with EV71 positive is more signif‐icant .The combined detection of serum NSE and CRP levels can be used as the early sensitive indicators for diagnosing HFMD complicating encephalitis .