手足口病合并脑炎患儿病情进展危险因素的分析及患儿血清、脑脊液中 VEGF和 VCAM-1的水平测定  

Study of the risk factors in disease progression and concentrations of VEGF and VCAM-1 in hand foot and mouth disease combined with encephalitis

作　　者：林建生[1] 彭维林[1] 潘万贵[1] 黎冉[1] 傅清流[1] 沈晓丽[1] 

机构地区：[1]泉州市儿童医院妇幼保健院,362000

出　　处：《中华微生物学和免疫学杂志》2013年第9期666-672,共7页Chinese Journal of Microbiology and Immunology

摘　　要：目的研究血管内皮生长因子（ vascular endothelial growth factor ，VEGF）和血管细胞间黏附分子-1（vascular intercellular adhesion molecule-1，VCAM-1）在手足口病（hand foot and mouth dis-ease，HFMD）合并脑炎患儿血清与脑脊液中的水平及变化规律，探讨VEGF和VCAM-1在手足口病合并脑炎中的意义及患儿手足口病合并脑炎疾病进展的危险因素。方法以92例手足口病患儿为研究对象，并将其分为A（手足口病无合并脑炎普通组）、B（手足口病合并脑炎重型组）、C（手足口病合并脑炎危重组）、D（手足口病合并脑炎恢复组）4组。采用双抗体夹心ELISA法检测血清及脑脊液VEGF与VCAM-1水平。采用多因素logistic回归对手足口病普通型与重型、重型与危重型之间具有统计学意义的项目进行手足口病合并脑炎病情进展危险因素分析。结果以SPSS16．0统计软件进行统计学处理，比较结果以P＜0．05为差异有统计学意义。结果血清与脑脊液VEGF、VCAM-1水平在A、B、C、D4组间相比较差异均有统计学意义，且 A组与B组、A组与C组、B组与D组、C组与D组之间血清与脑脊液VEGF、VCAM-1水平差异亦均有统计学意义，而A组与D组、B组与C组之间血清、脑脊液VEGF、VCAM-1比较差别均无统计学意义。此外手足口病普通型与重型之间具有统计学意义的项目还有热程、肢体抖动、脑脊液白细胞（ WBC）计数、脑脊液蛋白、EV71型IgM。重型与危重型之间具有统计学意义的项目有呼吸次数、心率、脑脊液WBC计数。经多因素logistic回归分析显示，手足口病无合并脑炎向合并脑炎重型进展的危险因素是肢体抖动、脑脊液蛋白、血清VEGF及VCAM-1，P值分别是0．071、0．019、0．020、0．025，OR值分别为147．629、26．572、5．958、6．345；手足口病合并脑炎重型向危重型进展危险因素是心率加快，P值是0．001，OR值为2．69。结论（1）手足Objective To explore the risk factors in disease progression and the significance of vascular endothelial growth factor （ VEGF ） and vascular intercellular adhesion molecule-1 （ VCAM-1 ） in hand foot and mouth disease （ HFMD） combined with encephalitis .Methods Altogether 92 subjects with HFMD were enrolled in the study and were divided into four groups , including group A （ ordinary group with no complication ） , group B （ severe group with complication ） , group C （ critical group with complication ） , group D （ recovery group with complication ） .Concentrations of VEGF and VCAM-1 in serum and cerebro-spinal fluid were detected by double antibody sandwich ELISA method .Multiple factors logistic regression＆nbsp;analysis was performed to analyze main risk factors in disease progression for two combinations , one for ordi-nary group and severe group , the other for severe group and critical group .The results were analyzed by SPSS16.0 statistical software.Results The concentration of VEGF and VCAM-1 in serum and cerebrospi-nal fluid had statistically significant differences among the four groups , but there was no significant difference between group A and group D , and between group B and group C .In addition , the statistically significant factors for prediction of disease progression were duration of fever , limb shaking, cerebrospinal fluid WBC , cerebrospinal fluid protein and EV 71 IgM between ordinary group and severe group , and cerebrospinal fluid WBC, respiratory rate and heart rate between severe group and critical group .The multiple factors logistic regression analysis revealed that limb shaking , cerebrospinal fluid protein , VEGF and VCAM-1 in serum were the main risk factors for disease progression from ordinary to severe （P=0.071, 0.019, 0.020, 0.025 and OR=147.629, 26.572, 5.958, 6.345）.And increased heart rate indicated the progression from se-vere to critical with P value of 0.001 and OR value of 2.69.Conclusion （1） Compared with group A, VEGF and VCAM-1 in

关 键 词：手足口病合并脑炎 血管内皮生长因子 血管细胞间黏附分子-1 病情进展 危险因素 

分 类 号：R725.1[医药卫生—儿科]