重症手足口病患儿T淋巴细胞亚群、血清炎性因子、心肌损伤指标和PEWS评分的变化及其意义  

Changes and significance of T lymphocyte subsets,serum inflammatory factors,myocardial injury index,and pews score in children with severe hand foot mouth disease

作　　者：王燕妮[1] 汤勉[1] 卜琰娜 WANG Yan-ni;TANG Mian;BU Yan-na(Pediatric Intensive Care Unit,Baoji Maternal and Child Health Hospital,Baoji 721000,Shaanxi,CHINA;Department of Pediatrics,People's Hospital of Hancheng City,Hancheng 715400,Shaanxi,CHINA)

机构地区：[1]宝鸡市妇幼保健院儿童重症科,陕西宝鸡721000 [2]韩城市人民医院儿科,陕西韩城715400

出　　处：《海南医学》2020年第24期3177-3180,共4页Hainan Medical Journal

摘　　要：目的观察重症手足口病患儿T淋巴细胞亚群、血清炎性因子、心肌损伤指标和和儿童早期预警评分(PEWS)的变化,并探讨其临床意义。方法回顾性分析2017年4月至2018年5月宝鸡市妇幼保健院收治的105例手足口病患儿的诊疗资料,根据病情程度不同分为A组75例(轻症)和B组30例(重症)。比较两组患儿治疗前、治疗1周后的T淋巴细胞亚群指标、炎症因子同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、血清N末端脑钠肽前体(NT-proBNP)、超敏肌钙蛋白T(hs-cTnT)、肌酸激酶同工酶(CK-MB)水平及PEWS评分变化情况,采用Spearman相关分析法分析血清NT-proBNP、hs-cTnT、CK-MB水平与PEWS评分的相关性。结果治疗1周后,A组患儿的CD3^+、CD8^+、CD4^+/CD8^+水平分别为(60.40±5.28)%、(44.06±2.27)%、1.07±0.20,明显高于B组的(53.36±5.24)%、(39.98±2.15)%、1.02±0.13,差异均有统计学意义(P<0.05);治疗1周后,A组患儿的血清Hcy、hs-CRP和IL-6水平分别为(13.97±0.55)μmol/L、(12.86±1.17)mg/L、(11.08±0.53)pg/L,明显低于B组的(18.08±0.62)μmol/L、(16.05±1.22)mg/L、(14.20±0.71)pg/L,差异均有统计学意义(P<0.05);治疗1周后,A组患儿的血清NT-proBNP、hs-cTnT、CK-MB及PEWS评分分别为(122.38±14.04)ng/L;(0.04±0.01)μg/L、(22.19±2.27)U/L、(4.74±0.90)分,明显低于B组的(1350.90±30.65)ng/L、(1.17±0.25)μg/L、(54.07±6.10)U/L、(5.73±1.06)分,差异均有统计学意义(P<0.05);Spearman相关分析结果显示,血清NT-proBNP、hs-cTnT、CK-MB与PEWS评分均呈正相关(r=0.511、0.639、0.720,P<0.05)。结论血清Hcy、hs-CRP、IL-6、NT-proBNP、hs-cTnT、CK-MB及PEWS评分在重症手足口病患儿中表达明显升高,T淋巴细胞亚群指标明显降低,均参与疾病的发生和发展,且NT-proBNP、hs-cTnT、CK-MB及PEWS评分之间具有相关性,对其检测有助于了解患儿病情变化。Objective To observe the changes of T lymphocyte subsets,serum inflammatory factors,myocardial injury indicators,and paediatric early warning system for children(PEWS)in children with severe hand,foot and mouth disease,and explore its clinical significance.Methods A retrospective analysis was made on the diagnosis and treatment of 105 children of hand-foot-mouth disease in Baoji Maternal and Child Health Hospital from April 2017 to May 2018.According to the degree of illness,they were divided into 75 cases with mild disease(group A)and 30 cases with severe disease(group B).The T lymphocyte subgroup indexes,inflammatory factors homocysteine(Hcy),high sensitivity C-reactive protein(hs-CRP),and interleukin-6(IL-6)before treatment and after 1 week of treatment between the two groups were compared,as well as serum N-terminal pro-brain natriuretic peptide(NT-proBNP),high-sensitivity troponin T(hs-cTnT),creatine kinase isoenzyme(CK-MB)levels,and PEWS score changes.Spearman correlation analysis was used to analyze the correlation between serum NT proBNP,hs-cTnT,CK-MB and PEWS score.Results One week after treatment,the CD3^+,CD8^+,CD4^+/CD8^+levels in group A were(60.40±5.28)%,(44.06±2.27)%,1.07±0.20,which were significantly higher than(53.36±5.24)%,(39.98±2.15)%,1.02±0.13 in group B(P<0.05);the serum Hcy,hs-CRP,and IL-6 levels in group A were(13.97±0.55)μmol/L,(12.86±1.17)mg/L,(11.08±0.53)pg/L,which were significantly lower than(18.08±0.62)μmol/L,(16.05±1.22)mg/L,(14.20±0.71)pg/L in group B(P<0.05);the levels of serum NT-proBNP,hs-cTnT,CK-MB,and PEWS scores in group A were(122.38±14.04)ng/L,(0.04±0.01)μg/L,(22.19±2.27)U/L,(4.74±0.90)points,which were significantly lower than(1350.90±30.65)ng/L,(1.17±0.25)μg/L,(54.07±6.10)U/L,(5.73±1.06)points in group B(P<0.05).Spearman correlation analysis showed that serum NT-proBNP,hs-cTnT,CK-MB and PEWS scores were positively correlated(r=0.511,0.639,0.720,P<0.05).Conclusion The serum Hcy,hs-CRP,IL-6,NT-proBNP,hs-cTnT,CK-MB,and PEWS scores are significantly in

关 键 词：重症手足口病 儿童 N末端脑钠肽前体 超敏肌钙蛋白T 肌酸激酶同工酶 儿童早期预警系统评分 

分 类 号：R729[医药卫生—儿科]