摘要
目的观察手足口病患儿血清促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、人类白细胞DR抗原(human leukocyte antigen DR,HLA-DR)水平变化及其与心肌损伤的关系。方法以成都儿童专科医院于2021年9月—2023年9月收治的160例手足口病患儿为研究对象,根据患儿是否发生心肌损伤分为无心肌损伤组(104例)和心肌损伤组(56例),观察患儿血清ACTH、HLA-DR水平以及心电图QT间期离散度(QT interval dispersion,QTcd)、心肌肌钙蛋白T(cardiac troponin T,cTnT)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)等指标,比较2组上述指标,分析心肌损伤的影响因素及ACTH、HLA-DR水平对心肌损伤的预测价值。结果心肌损伤组ACTH、QTcd、CK、CK-MB、cTnT水平高于无心肌损伤组,HLA-DR水平低于无心肌损伤组(P均<0.05)。多因素Logistic回归分析结果显示,ACTH、HLA-DR、QTcd、CK-MB、CK、cTnT、发热持续时间、白细胞计数、人β-葡萄糖醛酸酶水平均是影响患儿发生心肌损伤的因素。受试者工作特征曲线分析显示,ACTH、HLA-DR联合检测心肌损伤诊断效能高于ACTH、HLA-DR单项检测。结论发生心肌损伤的手足口病患儿血清ACTH水平升高、HLA-DR水平下降,2者联合检测可预测患儿发生心肌损伤。
Objective To observe and study the changes in serum adrenocorticotropic hormone(ACTH)and human leukocyte antigen DR(HLA-DR)levels in children with hand,foot,and mouth disease,and their relationship with myocardial injury.Methods A retrospective analysis was conducted on 160 children with hand,foot,and mouth disease admitted to Chengdu Children’s Hospital from September 2021 to September 2023.The patients were divided into 2 groups based on whether they had myocardial injury:no myocardial injury group(104 cases)and myocardial injury group(56 cases).The serum ACTH and HLA-DR levels,QT interval dispersion(QTcd),troponin T(cTnT),creatine kinase(CK),and creatine kinase isoenzyme(CK-MB)were observed in the patients.The 2 groups were compared in terms of the indicators mentioned above,and the influencing factors of myocardial injury and the predictive value of ACTH and HLA-DR levels on myocardial injury were analyzed.Results The levels of ACTH,QTcd,CK,CK-MB,and cTnT in the myocardial injury group were higher than those in the non-myocardial injury group,while the levels of HLA-DR were lower than those in the non myocardial injury group(P<0.05).The results of multivariate logistic regression analysis showed that ACTH,HLADR,QTcd,CK-MB,CK,cTnT,duration of fever,white blood cell count,and humanβ-The levels of glucuronidase are all factors that affect the occurrence of myocardial injury in children.ROC curve analysis shows that the diagnostic efficiency of ACTH and HLA-DR combined detection for myocardial injury is higher than that of ACTH and HLA-DR single detection.Conclusion Children with hand,foot,and mouth disease who experience myocardial injury have elevated serum ACTH levels and decreased HLA-DR levels.The combined detection of the two can predict the occurrence of myocardial injury in the child’s heart.
作者
陈娜
蔡晶娟
谢巧林
王紫荆
CHEN Na;CAI Jingjuan;XIE Qiaolin;WANG Zijing(Pediatric Department,Chengdu Children’s Special Hospital,610000,China)
出处
《传染病信息》
2024年第2期153-157,共5页
Infectious Disease Information
基金
四川省卫生和计划生育委员会科研课题(17PJ267)。
