手足口病合并脑炎患儿血清和脑脊液中MMP-9和TIMP-1水平的临床价值分析  

Analysis of serum and cerebrospinal fluid MMP-9 and TIMP-1 levels and risk factors of disease progression in children with hand-foot-mouth disease complicated with encephalitis

作　　者：史晓玲 马小云 拜翠莲 Shi Xiaoling;Ma Xiaoyun;Cui Lian(Department of Neurology,Qinghai Province Women and Children's Hospital,Qinghai Xining 81007,China)

机构地区：[1]青海省妇女儿童医院神经内科,青海西宁810007

出　　处：《中国妇幼健康研究》2023年第5期16-24,共9页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨手足口病合并脑炎患儿血清和脑脊液中基质金属蛋白酶-9(MMP-9)、组织型基质金属蛋白酶抑制剂-1(TIMP-1)水平及其比值对病情评估的临床价值。方法 选取2018年1月至2022年2月青海省妇女儿童医院收治的107例手足口病患儿为研究对象,根据是否伴有颅内感染性脑炎将患儿分为研究组(n=62)与对照组(n=45),再根据感染程度将研究组分为轻症组(n=38)与重症组(n=24)。收集患儿的临床资料及实验室检测指标,经过临床2~3周治疗后,对处于恢复期的研究组患儿复查血清和脑脊液有关指标。比较研究组与对照组的临床资料,以多因素Logistic回归分析手足口病患儿无合并脑炎向合并脑炎进展的独立危险因素,比较研究组患儿治疗前后血清和脑脊液中MMP-9、TIMP-1水平及其比值的变化情况,采用Pearson分析血清和脑脊液中MMP-9、TIMP-1的相关性,以受试者工作特征(ROC)曲线预测MMP-9、TIMP-1及其比值对手足口病合并脑炎的诊断价值。结果 研究组与对照组的病程、白蛋白(Alb)、C反应蛋白(CRP)、血清白细胞计数(WBC)、血清中性粒细胞百分比(NEUT)、血清MMP-9、血清TIMP-1、血清MMP-9/TIMP-1、免疫球蛋白(Ig)A、IgM、IgG、脑脊液WBC、脑脊液蛋白、脑脊液MMP-9、脑脊液TIMP-1、脑脊液MMP-9/TIMP-1比较差异均有统计学意义(t=2.134~226.271,P<0.05)。多因素Logistic回归分析显示,病程、CRP、血清WBC、血清NEUT、血清MMP-9、血清TIMP-1、血清MMP-9/TIMP-1、IgA、脑脊液蛋白、脑脊液MMP-9、脑脊液TIMP-1、脑脊液MMP-9/TIMP-1均是影响手足口病患儿无合并脑炎向合并脑炎进展的独立危险因素(Waldχ^(2)=1.725~9.225,P<0.05)。治疗前,轻症组和重症组患儿血清和脑脊液中MMP-9、TIMP-1、MMP-9/TIMP-1均明显高于对照组(轻症组治疗前与对照组比较:t值分别为77.410、10.873、3.396、18.046、3.244、5.095,重症组治疗前与对照组比较:t值分别为123.273、19.895、Objective To investigate the clinical values of serum and cerebrospinal fluid matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloprotease-1(TIMP-1) levels and their ratio for disease assessment in children with hand-foot-and-mouth disease complicated with encephalitis.Methods A total 107 children with hand-foot-and-mouth disease and admitted to the Qinghai Province Women and Children′s Hospital from January 2018 to February 2022 were selected as the study objects.According to whether accompanied by intracranial infectious encephalitis or not, they were divided into the study group(n=62) and the control group(n=45),and the study group were further divided into the mild group(n=38) and the severe group(n=24) according to the degree of infection.The clinical data and laboratory test indexes of children were collected.After clinical 2-3 weeks′ treatment, serum and cerebrospinal fluid related indexes were reviewed for convalescent children in the study group.The clinical data was compared between the study group and the control group.Multivariate Logistic regression analysis was performed to analyze the independent risk factors for the progression from without encephalitis to with encephalitis in children with hand-foot-and-mouth disease.The serum and cerebrospinal fluid levels of MMP-9 and TIMP-1 and their ratio in the study group were compared before and after treatment.Pearson correlation was used to analyze the correlation of MMP-9 and TIMP-1 in serum and cerebrospinal fluid.Receiver operating characteristic(ROC) curve was used to predict the values of MMP-9 and TIMP-1 and their ratio in the diagnosis of hand-foot-and-mouth disease complicated with encephalitis.Results There were significant differences in disease course, albumin(Alb),C-reactive protein(CRP),serum white blood cell count(WBC),serum neutrophil percentage(NEUT),serum MMP-9,serum TIMP-1,serum MMP-9/TIMP-1,immunoglobulin(Ig) A,IgM,IgG,cerebrospinal fluid WBC,cerebrospinal fluid protein, cerebrospinal fluid MMP-9,cerebrospinal fluid TI

关 键 词：手足口病 脑炎 脑脊液 基质金属蛋白酶-9 组织型基质金属蛋白酶抑制剂-1 

分 类 号：R175[医药卫生—妇幼卫生保健]