高迁移率族蛋白1与肠道病毒71型手足口病重症化的相关性研究

目的通过对不同严重程度手足口病(hand,foot and mouth disease,HFMD)血浆高迁移率族蛋白1(high mobility group protein 1,HMGB1)水平进行检测,研究HMGB1水平与肠道病毒71型(enterovirus 71,EV71)HFMD重症化的相关性。方法选取西安市儿童医院2018年4月至2019年12月收治住院的EV71型HFMD患儿共150例为研究对象,其中普通型100例(普通型组),重症50例(重症组)。选择同期儿童保健科体检的健康儿童50例为对照组,采用ELISA方法检测血浆HMGB1的水平。收集病例组临床资料及实验室检查,对可能影响普通型HFMD转为重症的相关因素进行单因素和多因素Logistic回归分析。结果EV71型HFMD患儿急性期HMGB1水平(13700±3036)pg/mL]较对照组(10116±2435)pg/mL]明显升高(t=5.913,P<0.05)。经治疗后恢复期HMGB1(10658±2349)pg/mL]水平下降,和对照组比较,差异无统计学意义(t=2.515,P>0.05)。重症组血糖、外周血白细胞计数、HMGB1水平均高于普通型组,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析发现,血糖>8.3 mmol/L、外周血白细胞>15×10⁹/L、HMGB1≥13110 pg/mL水平为EV71型HFMD患儿重症化的危险因素。受试者工作特征曲线分析提示,当HMGB1为13110 pg/mL时约登指数最大,该值对应的敏感度为81.6%,特异度为72.0%。结论WBC>15×10⁹/L、血糖>8.3 mmol/L、HMGB1≥13110 pg/mL水平均为HFMD重症化的危险因素,HMGB1水平与EV71型HFMD的严重程度存在相关性。

Study on the relationship between high mobility group protein 1 and the severity of enterovirus 71 hand,foot and mouth disease

Objective To study the relationship between the level of high mobility group protein 1(HMGB1)and the severity of hand,foot and mouth disease(HFMD).Methods A total of 150 children with enterovirus 71(EV71)HFMD admitted to Xi′an Children′s Hospital from April 2018 to December 2019 were selected as the study objects,including 100 mild cases(normal group)and 50 severe cases(severe group).Meanwhile,50 healthy children during the same period were selected as control group.The level of HMGB1 in plasma was detected by ELISA.The clinical data and laboratory examination of the case group were collected.The factors that may affect the conversion of HFMD to severe were analyzed by single factor and multi-factor Logistic regression analysis.The risk factors of conversion of HFMD to severe and the correlation between the level of HMGB1 in plasma and the severity of HFMD were discussed.Results The level of HMGB1 in EV71 HFMD children in the acute stage(13700±3036)pg/mL]was significantly higher than that in the control group(10116±2435)pg/mL](t=5.913,P<0.05).After treatment,the level of HMGB1 decreased in the convalescence period(10658±2349)pg/mL],and the difference was not statistically significant compared with the control group(t=2.515,P>0.05).Blood glucose,white blood cell count and HMGB1 level in the severe group were all higher than those in the normal group(all P<0.05).Multivariate Logistic regression analysis found that the levels of blood glucose>8.3 mmol/L,peripheral blood leukocyte>15×10⁹/L,and HMGB1≥13110 pg/mL were the risk factors for severe aggravation of HFMD in children.The receiver operating characteristic curve analysis showed that when HMGB1 was 13110 pg/mL,the Yoden index was the highest,with a sensitivity of 81.6%and a specificity of 72.0%.Conclusion WBC>15×10⁹/L,blood glucose>8.3 mmol/L and HMGB1≥13110 pg/mL are the risk factors of HFMD.When HMGB1 is higher than,it suggests that HFMD may develop to severe.