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| 手足口病患儿血清ACTH、HLA-DR水平变化及其与心肌损害的关系 |
| Changes of serum ACTH and HLA-DR levels and their relationship with myocardial damage in children with hand, foot and mouth disease |
| 投稿时间：2023-10-31 修订日期：2024-05-01 |
| DOI： |
| 中文关键词: 手足口病 血清ACTH HLA-DR 心肌损害 |
| 英文关键词: Hand, foot and mouth disease Serum ACTH HLA-DR Myocardial damage |
| 基金项目:四川省卫生和计划生育委员会科研课题（17PJ267） |
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| 中文摘要: |
| 目的：观察研究手足口病患儿血清ACTH、HLA-DR水平变化及其与心肌损害的关系。方法：选取成都儿童专科医院收治于2021年9月~2023年9月的手足口病患儿160例为观察组,同期选取本院体检健康患儿155例为对照组,观察患儿血清促肾上腺皮质激素(ACTH)、HLA-DR水平、心电图检查计算QT间期离散度(QT interval dispersion,QTcd)、肌钙蛋白T(Troponin T,cTnT)、肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌酸激酶(Creatine kinase,CK),并分析血清ACTH、HLA-DR水平与血清心肌酶学指标、QTcd的相关性及对心肌损害的预测价值。结果：对照组患儿ACTH水平与观察组相比,呈降低趋势,而HLA-DR水平高于观察组；而观察组轻症患儿血清ACTH水平低于重症患儿,HLA-DR水平高于重症患儿,差异具有统计学意义(P＜0.05)；观察组患儿与对照组相比,QTcd水平下降,而CK-MB、CK、cTnT水平均上升；观察组患儿中未发生心肌损害中血清ACTH、QTcd、CK-MB、CK、cTnT水平均低于发生心肌损害的患儿,而HLA-DR水平增高,差异具有统计学意义(P＜0.05)；根据Spearman相关性分析结果显示,观察组患儿ACTH水平与心肌酶学指标及QTcd水平呈正相关性,而HLA-DR水平呈负相关性,差异具有统计学意义(P＜0.05)。ROC曲线显示,联合检测心肌损害发生的诊断效能显著高于血清ACTH、HLA-DR单一检测。结论：在手足口病患儿中尤其是重症患儿血清ACTH、HLA-DR水平过度异常,并且两者与心肌损害指标均具有相关性,可以作为临床心肌损伤评估,为临床治疗提供参考价值。 |
| 英文摘要: |
| Objective:To observe the changes of serum ACTH and HLA-DR levels in children with hand, foot and mouth disease and their relationship with myocardial damage.Methods:160 children with HFMD treated in our hospital from September 2021 to September 2023 were selected as the observation group, and 155 healthy children with physical examination in our hospital were selected as the control group during the same period. Serum adrenocorticotropic hormone (ACTH), HLA-DR levels, QT interval dispersion (QTcd) and Troponin T (Troponin T) were measured by electrocardiogram. cTnT), Creatine kinase isoenzyme (CK-MB), Creatine kinase (CK), and the correlation between serum ACTH, HLA-DR levels and serum myocardial enzymology indexes, QTcd and the predictive value of myocardial damage were analyzed.Results:Compared with the observation group, the ACTH level of the control group was decreased, while the HLA-DR level was higher than that of the observation group. In the observation group, the serum ACTH level of mild children was lower than that of severe children, and the HLA-DR level was higher than that of severe children, the difference was statistically significant (P < 0.05). Compared with the control group, QTcd levels in observation group decreased, while CK-MB, CK and cTnT levels increased. The serum levels of ACTH, QTcd, CK-MB, CK and cTnT in the observation group without myocardial damage were lower than those in the children with myocardial damage, while the level of HLA-DR was increased, with statistical significance (P < 0.05). According to Spearman correlation analysis, ACTH level in the observation group was positively correlated with myocardial enzyme indexes and QTcd level, while HLA-DR level was negatively correlated, with statistical significance (P < 0.05). ROC curve showed that combined detection was significantly more effective in predicting myocardial damage than serum ACTH and HLA-DR single detection.Conclusion:Excessive abnormal levels of serum ACTH and HLA-DR are found in children with HFMD, especially in severe children, and both are correlated with myocardial damage indicators, which can be used as clinical myocardial damage assessment and provide reference value for clinical treatment. |
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