Studies On Predictors With Severe Hand-foot-mouth Disease And Measures Of Norepinephrine In Blood Serum

Objective:Hand-foot-mouth disease (HFMD) is a kind of common paediatric acute infectious disease. The main pathogen of HFMD is enterovirus, including coxsackie virus group A and EV71. The disease derives its name from the characteristic popular or vesicular lesions involving primarily the skin of the hands and feet, and the buccal mucosa. The prognosis about most patients with mild symptoms is satisfactory. A few of patients may be complicated by aseptic meningitis, encephalitis, acute flaccid paralysis, myocarditis and pulmonary edema, and so on. Because of the high mortality rate and the high disability rate, it does great harm to infants'life and health. The main cause of death about HFMD is neurogenic pulmonary edema. There are three pathogenesises of neurogenic pulmonary edema: dynamic theory, permeability theory and blast injury theory. The common of the three theories is that the sympathetic nerves are stimulated, catecholamine levels in the blood are increased and pulmonary edema is caused through different mechanisms. When the central nerves systems of children with HFMD were damaged, the over-stress of the body is caused, sympathetic nerves are excited, and lead to norepinephrine in the blood are increased. And norepinephrine can cause serious complications even death. Therefore, the levels of norepinephrine in the blood about children with HFMD should be measured and the pathophysiological mechanism through disease progress should be observed in order to combine other indicators to research predictors of severe HFMD.Methods:304 cases of children who were diagnosed with HFMD and hospitalized in Maternal and Child Health Hospital of Handan City from April 2009 to July 2009, and 19 cases of children who died of HFMD in Hebei Province in 2008 and 2009. According to" Hand, Foot and Mouth Disease diagnosis and treatment guidelines (2009 and 2010 edition) " formulated by the Ministry of Health, the objects were divided into three groups: groups A(231cases),group B(73cases), group C(19cases). Venous blood samples were collected after the patients were admitted to the hospital. The at least 3 ml blood samples of each patient which were immediately sent to the laboratory. Serum was separated from the blood and then was stored in refrigerator. And at the same time blood-routine-test, cardiac enzymes, blood glucose and etiology were all tested.All the data were analyzed by SPSS 13.0, p<0.05 was regarded as statistical significance.Results:1 The children less than 3 years old(including 3 years)were 288 cases and they accounted for 89.2%of the objects, The children with the age between 0.5 years old and 1.5 years old of the group C were more than other two groups and the difference had statistical significance. The ratio of males to females was 1.67.2 Group C had higher temperature than other two groups, fever symptom of the 318 cases lasted for 3-5 days accounting for 60.4% proportion (191/323).3 322(99.7%) cases had rash with different parts, and among them 105 cases (32.6%) had the highest percentage as they had rash with hand, foot, mouth and hip at the same time.1case in group C had no rash.4 All of the cases had nervous system symptoms, the most common symptoms were hyperarousal and poor vitality.5 Circulatory system: breathing, heart rate and blood pressure gradually increased when the illness growing worse.6 WBC of the three groups were (11.55±4.35)×10~9/L, (13.04±5.19)×10~9/L, (22.89±10.60)×10~9/L. The difference between group A and group B had no statistically significant (P>0.05), as the differences between group A and group C, group B and group C had statistically significant (P<0.05).7 Blood glucose of the three groups were 7.38±2.44mmol/L, 8.61±3.04 mmol/L, 14.47±8.80mmol/L. The difference between group A and group B had no statistically significant (P=0.078), but the differences between group A and C, group B and C had statistically significant (P<0.05).The blood glucose level of group C was higher than other two groups.8 CRP of the three groups were 5.91±13.37mg/L, 7.79±16.73mg/L, 3.68±5.40 mg/L, the difference among the three groups had no statistically significant.9 Enzyme of the three groups:CK-MB of group C was higher than other two groups. The difference between group A and group B had no statistically significant (P=0.839), but the differences between group A and group C, group B and group C had statistically significant (P<0.05). The differences ofα-HBDH and LDH among the three groups had no statistically significant.10 The CSF leukocyte level of group C was higher than group A, and the difference had statistically significant (P<0.05). The differences between group A and group B, group B and group C had no statistically significant. The difference of CSF protein among the three groups had statistically significant (p<0.001). Group C had higher level than other two groups. The difference between group A and group B had no statistically significant (P=0.086).11 Severe cases were closely related to EV71 infection.107 cases had etiology laboratory results, including 75 cases with EV71 (70.1%).The EV71 positive rate between group A and group BC had statistically significant.12 Norepinephrine level of the three groups were 539.455±384.206ng/L, 34.344±393.461ng/L, 882.015±403.812ng/L. The difference among the three groups had no statistically significant (p>0.05), and the differences between every two groups had no statistically significant while the difference between group A and group BC had statistically significant (p=0.046). Norepinephrine level of severe group had lower level than other two groups.13 The results of logistic regression analysis showed: respiratory rate≥40 beats/min and heart rate≥140beats/min were the risk factors for critical cases .Respiration≥50beats/min was the major risk factor for death.Conclusions:1 The vital signs of patients with HFMD monitored closely, especially breathing and heart beat, could help to find severe cases earlier.2 The short-term increases of WBC, blood glucose, myocardial enzymes (CK–MB) and CSF protein are the important indexes wich patient,s condition worsen.3 The more attention to the cases with EV71 infection should be payed, because EV71 is a important index for severe and dead cases. 4 Norepinephrine level is primary to the increase of heart rate, breathing, blood pressure, blood glucose and CK-MB.