The Expressions Of Serum、Cerebrospinal Fluid VEGF And VCAM–1in Hand-foot-and-mouth Disease Complicated With Encephalitis Children And The Analysises For The Risk Factors Of Their Disease Progression

Objective:To research the level and the variational rule of vascular endothelialgrowth factor (VEGF) and vascular intercellular adhesion molecule-1(VCAM-1)in serum and cerebrospinal fluid of hand-foot-mouth disease complicated withencephalitis children, and to discuss the significance of VEGF and VCAM-1in thehand-foot-mouth disease complicated with encephalitis children,and the risk factors ofdisease progression in the hand-foot-mouth disease complicated with encephalitischidren.Methods:Collected92cases hand-foot-and-mouth disease (HFMD) children asreseached objects. All of cases were divided into group A、B、C、D four groups. GroupA which had25cases was the ordinary group of HFMD no complicated withencephalitis (for short ordinary group). Group B which had44cases was thesevere group of HFMD complicated with encephalitis (for short severe group). GroupC which had23cases was the critical group of HFMD complicated with encephalitis(for short critical group). Group D which had27cases was the recovery group fromthe above B and C group by random selection (for short recovery group).VEGF、VCAM–1were detected by double antibody sandwich ELISA method. Clinicaldata indexes of the probable risk factors of disease progression inhand-foot-and-mouth disease complicated with encephalitis children included age、gender、weight、fever、rash、frightened jump、vomiting、convulsions、mental fatigue、 meningeal stimulation、body jitter、respiratory frequency、heart rate and so on,andassistant check indexes included peripheral blood WBC、blood glucose、cerebrospinalfluid WBC、cerebrospinal fluid protein、 serum IgG、 serum IgM、serum IgA、serum EV71IgM、chest radiograph、electroencephalogrom and so on. Multiplefactors logistic regression analyed main disease progression risk factors fromstatistically significant risk factors above.The results were analyed by SPSS16.0statistical software. The comparison result of P <0.05was considered to bestatistically significant.Results:(1) The differences betweenA, B, C, D four groups of gender、age andweight were not statistically significant. The measured values of serum VEGF in A、B、 C、D group were respectively95.83±26.17pg/ml、150.92±42.41pg/ml、160.16±35.61pg/ml、91.92±33.57pg/ml;The measured values of serum VCAM-1inA、B、 C、D group were respectively376.44±52.03×103pg/ml、482.26±56.9×103pg/ml、498.00±57.88×103pg/ml、363.81±60.33×103pg/ml; The measured valuesof cerebrospinal fluid VEGF in A、B、 C、D group were respectively19.00±4.09pg/ml、37.30±5.71pg/ml、38.15±4.61pg/ml、20.89±4.76pg/ml;The measuredvalues of cerebrospinal fluid VCAM-1in A、B、 C、D group were respectively16.76±4.47×103pg/ml、29.84±6.90×103pg/ml、31.00±6.33×103pg/ml17.35±4.92×103pg/ml.The differences betweenA, B, C, D four groups of serum and cerebrospinalfluid VEGF, VCAM-1were statistically significant, and furthercomparison,differences between group A and group B, group A and group C，group Band group D, group C and group D for serum, cerebrospinal fluid VEGF, VCAM-1were statistically significant,but differences between group A and group D, B and Cgroup for serum and cerebrospinal fluid VEGF, VCAM-1were no statisticalsignificances. The areas under curve (AUC) of ROC of serum VEGF、 serumVCAM-1、 cerebrospinal fluid VEGF、 cerebrospinal fluid VCAM-1inhand-foot-and-mouth disease complicated with encephalitis children wererespectively0.885、0.921、0.999and0.954.Because the AUC of cerebrospinal fluidVEGF was largest among them, its diagnostic accuracy was best. whencerebrospinal fluid VEGF cutoff value was29.19pg/ml, Youden index was the highest(1.97) correspondently, and the sensitivity、 specificity were respectively97%、100%. The AUC of serum VEGF、 serum VCAM-1、cerebrospinal fluidVEGF、cerebrospinal fluid VCAM-1in hand-foot-and-mouth disease complicatedwith encephalitis critical children were respectively0.709、0.721、0.722and0.694.The AUC of cerebrospinal fluid VEGF was largest among them.when cerebrospinalfluid VEGF cutoff value was30.70pg/ml, Youden index was the highestcorrespondently, and the sensitivity、specificity were respectively100%、42%.(2)The differences betweenA, B, C three groups for fever continued days、body jitter、respiratory frequency、heart rate、cerebrospinal fluid WBC count、cerebrospinal fluidprotein content、serum IgA content、type EV71IgM positive ratio were all statisticallysignificant.The result of the multi-factor logistic regression analysis revealed that fordisease progression from hand-foot-and-mouth disease no complicated withencephalitis group to Hand-foot-and-mouth disease complicated with encephalitissevere group, the main risk factors were body jitter、 cerebrospinal fluid protein、serum VEGF and VCAM-1and their B values were respectively4.995、3.280、1.785、1.848, and their P values were respectively0.071、0.019、0.020、0.025，and theirb，values were7.60、2.53、0.75、0.84, and their OR values were respectively147.63、26.57、5.96、6.35; for disease progression from hand-foot-and-mouth diseasecomplicated with encephalitis severe group to Hand-foot-and-mouth diseasecomplicated with encephalitis critical group, the main risk factor was heart rate,and itsB values was0.990, and its P value was0.001,and its b，was1.61,and its OR valuewas2.69.Conclusions:(1)The expressiones of serum and cerebrospinal fluid VEGF, VCAM–1were high concentrationes in hand-foot-and-mouth disease complicated withencephalitis children.They provided the basis for auxiliary differential diagnosis ofhand-foot-and-mouth disease children who were whether complicated withencephalitis or not，and to a certain extent, reflected the severity and prognosis ofdisease.The diagnostic accuracy of cerebrospinal fluid VEGF forhand-foot-and-mouth disease complicated with encephalitis was best.When its cutoff value was29.19pg/ml, its diagnostic efficiency is best.(2) body jitter、cerebrospinalfluid protein、 serum VEGF and VCAM-1were the main risk factors for diseaseprogression from hand-foot-and-mouth disease no complicated with encephalitisgroup to complicated with encephalitis severe group; and heart rate was the main riskfactor for disease progression from hand-foot-and-mouth disease complicated withencephalitis severe group to complicated with encephalitis critical group.