重症手足口病患儿血清S100B和NSE水平与颅脑MRI的诊断  

Serum levels of S100B and NSE and the change of brain magnetic resonance imaging in the children with severe hand-foot-mouth disease

作　　者：黄月艳[1,2] 柳国胜[1] 韦叶生[2] 李强[2] 黄云峰[2] 黄肯[1] 游金勇[1] 黄致敬 韦爱伯[1] 罗秀状[1] 罗燕飞[2] 

机构地区：[1]暨南大学附属第一医院儿科,广东广州510632 [2]右江民族医学院附属医院儿科,广西百色533000

出　　处：《中华危重病急救医学》2016年第11期1019-1022,共4页Chinese Critical Care Medicine

基　　金：广西卫生计生委重点项目基金（S201318-01）

摘　　要：目的：探讨肠道病毒71型（EV71）病毒感染的重症手足口病（HFMD）患儿血清星形胶质源性蛋白（S100B）和神经元特异性烯醇化酶（NSE）水平变化与颅脑磁共振成像（MRI）检查阳性的关联性。方法选择右江民族医学院附属医院儿科收治的60例EV71感染的HFMD患儿，按病情分为重症组（24例）和普通组（36例）。于入院后6、24、48、72h时检测血清S100B、NSE水平，并于入院后24h进行MRI检查。以同期30例同龄健康体检者作为健康对照组。结果重症组6、24、48、72h血清S100B和NSE水平显著高于普通组和健康对照组〔S100B（μg/L）：6h为1.29±0.13比0.15±0.03、0.13±0.02，24h为1.56±0.16比0.13±0.02、0.13±0.02，48h 为1.66±0.15比0.16±0.02、0.13±0.02，72h 为1.60±0.16比0.16±0.02、0.13±0.02；NSE （μg/L）：6h为42.36±5.48比5.95±0.14、5.61±0.20，24h为50.13±5.58比6.16±0.15、5.61±0.20，48h为59.36±5.94比6.07±0.14、5.61±0.20，72h为56.78±5.07比5.86±0.16、5.61±0.20，均P＜0.01〕；普通组与健康对照组各时间点比较差异无统计学意义（均P＞0.05）。重症组MRI检查发现单发或多发脑实质损伤患儿各6例，损伤部位以基底节、丘脑及脑干区多见，其血清S100B、NES水平显著高于无脑实质损伤者〔S100B （μg/L）：1.64±0.15、1.72±0.14比1.49±0.16，NES（μg/L）：52.14±5.08、54.50±4.85比47.14±4.65，均P＜0.05〕。结论重症HFMD患儿血清S100B、NSE水平明显升高，有脑实质损伤现象的患儿更高。Objective To investigate the relationship between the changes in the serum levels of astrocyte derived protein （S100B）, neuron specific enolase （NSE） and the change of brain magnetic resonance imaging （MRI） in children with severe hand-foot-mouth disease （HFMD） induced by human enterovirus 71 （EV71） infection. Methods Sixty children with EV71 infected HFMD admitted to Department of Pediatrics of Affiliated Hospital of Youjiang Medical University for Nationalities were enrolled, and they were divided into severe group （n = 24） and mild group （n = 36） according to disease severity. Serum levels of S100B and NSE at 6, 24, 48 and 72 hours after hospital admission were determined, and MRI was administrated at 24 hours after hospital admission. Thirty healthy children with the same age were served as healthy control group. Results The serum levels of S100B and NSE at 6, 24, 48 and 72 hours in the severe group were significantly higher than those of mild group and healthy control group [S100B （μg/L）： 1.29±0.13 vs. 0.15±0.03, 0.13±0.02 at 6 hours, 1.56±0.16 vs. 0.13±0.02, 0.13±0.02 at 24 hours, 1.66±0.15 vs. 0.16±0.02, 0.13±0.02 at 48 hours, 1.60±0.16 vs. 0.16±0.02, 0.13±0.02 at 72 hours; NSE （μg/L）： 42.36±5.48 vs. 5.95±0.14, 5.61±0.20 at 6 hours, 50.13±5.58 vs. 6.16±0.15, 5.61±0.20 at 24 hours, 59.36±5.94 vs. 6.07±0.14, 5.61±0.20 at 48 hours, 56.78±5.07 vs. 5.86±0.16, 5.61±0.20 at 72 hours, all P 〈 0.01]. There was no statistically significant difference between the mild group and the control group at each time point （all P 〉 0.05）. Brain parenchyma damages in MRI were presented with single brain parenchyma damage （6 cases） and multiple brain parenchyma damage （6 cases） in 50% of children in the severe group. The basal ganglia, thalamus and brainstem were the common locations of damage, and the serum levels of S100B and NES were significantly higher than those without brain parenchyma damage [S100B （μg/L）： 1.64±0.15, 1.72±0.14 vs.

关 键 词：手足口病 星形胶质源性蛋白 神经元特异性烯醇化酶 磁共振成像 

分 类 号：R725.1[医药卫生—儿科]