手足口病合并脑炎患儿细胞免疫水平与其预后的关系  

Relationship between cellular immunity level and prognosis in children with hand-foot-mouth disease combined with encephalitis

作　　者：张艳[1] 于安平[1] 徐晓科[2] 姚雯[2] ZHANG Yan;YU An-ping;XU Xiao-ke;YAO Wen(Department of Pediatrics,the Fourth Hospital of Xi'an,Xi'an 710001,Shaanxi,CHINA;Department of Neurology,the Children's Hospital of Xi'an,Xi'an 710003,Shaanxi,CHINA)

机构地区：[1]西安市第四医院儿科,陕西西安710001 [2]西安市儿童医院神经内科,陕西西安710003

出　　处：《海南医学》2019年第23期3085-3087,共3页Hainan Medical Journal

摘　　要：目的分析手足口病(HFMD)合并脑炎患儿细胞免疫水平与其预后的关系。方法回顾性分析西安市第四医院2017年8月至2018年8月收治的100例HFMD患儿(HFMD组)的临床资料,根据是否合并脑炎分为脑炎组59例及非脑炎组41例,并选择同期进行健康体检的同龄儿童50例作为对照组,检测各组受检者的细胞免疫(CD3^+、CD4^+、CD8^+等T细胞亚群)水平,并利用受试者工作曲线(ROC)分析细胞免疫水平与预后之间的关系。结果HFMD组患儿的T细胞亚群(CD3^+、CD4^+、CD8+)水平[(46.57±9.72)%、(23.55±5.31)%、(21.37±4.31)%]明显低于对照组[(68.49±12.28)%、(39.40±6.46)%、(27.41±4.64)%],差异均有统计学意义(P<0.05);脑炎组患儿T细胞亚群(CD3^+、CD4^+、CD8^+)水平[(38.42±6.73)%、(19.84±5.12)%、(15.37±3.64)%]明显低于非脑炎组患儿[(51.35±7.16)%、(27.68±5.51)%、(20.68±5.18)%],差异均有统计学意义(P<0.05);脑炎组患儿中有15例死亡,死亡组患儿T细胞亚群(CD3^+、CD4^+、CD8^+)水平[(35.42±2.73)%、(17.84±2.12)%、(13.37±1.64)%]明显低于存活组[(41.26±3.24)%、(21.68±2.51)%、(16.68±1.85)%],差异均有统计学意义(P<0.05);ROC分析结果显示,CD3^+、CD4^+、CD8^+单独及联合预测HFMD合并脑炎死亡的ROC曲线下面积(AUC)分别为0.772、0.779、0.770、0.929,CD3^+、CD4^+、CD8^+的Cut off值分别为39.18%、18.25%、14.00%,三者联合预测的AUC值明显高于CD3^+、CD4^+、CD8^+单项预测,差异均有统计学意义(P<0.05)。结论HFMD合并脑炎患儿细胞免疫功能降低,CD3+≤39.18%、CD4^+≤18.25%、CD8^+≤14.00%时提示HFMD合并脑炎患儿病情进一步恶化。Objective To analyze relationship between cellular immunity level and prognosis in children with hand-foot-mouth disease(HFMD)combined with encephalitis.Methods The clinical data of 100 HFMD children(HFMD group)who were admitted to the Fourth Hospital of Xi’an from August 2017 to August 2018 were retrospectively analyzed.According to presence or absence of encephalitis,they were divided into encephalitis group(59 children)and nonencephalitis group(41 children).Another 50 children undergoing healthy physical examination in the same period were enrolled as control group.The levels of cellular immunity(CD3^+,CD4^+,and CD8^+)in each group were detected.The relationship between cellular immunity level and prognosis was analyzed by receiver operating characteristic(ROC)curves.Results The levels of T cell subsets(CD3^+,CD4^+,CD8^+)in HFMD group were(46.57±9.72)%,(23.55±5.31)%,(21.37±4.31)%,significantly lower than(68.49±12.28)%,(39.40±6.46)%,(27.41±4.64)%in control group(P<0.05).The above indexes in encephalitis group were(38.42±6.73)%,(19.84±5.12)%,(15.37±3.64)%,significantly lower than(51.35±7.16)%,(27.68±5.51)%,(20.68±5.18)%in non-encephalitis group(P<0.05).In encephalitis group,there were 15 cases died.The levels of T cell subsets(CD3^+,CD4^+,CD8^+)in death group were(35.42±2.73)%,(17.84±2.12)%,(13.37±1.64)%,significantly lower than(41.26±3.24)%,(21.68±2.51)%,(16.68±1.85)%in survival group(P<0.05).ROC analysis results showed that areas under ROC curve(AUC)of CD3+,CD4+,CD8+alone and their combination for predicting HFMD combined with encephalitis death were 0.772,0.779,0.770,and 0.929,respectively.The cut off values of CD3^+,CD4^+,and CD8^+were 39.18%,18.25%,and 14.00%,respectively.AUC of combination prediction of the three was significantly higher than that of CD3^+,CD4^+,and CD8^+alone(P<0.05).Conclusion The cellular immune function of children with HFMD and encephalitis is decreased.CD3^+≤39.18%,CD4^+≤18.25%,and CD8^+≤14.00%indicate that conditions of children with HFMD and encephalitis a

关 键 词：手足口病 脑炎 细胞免疫 预后 相关性 

分 类 号：R725.9[医药卫生—儿科]