| Objectives:HFMD(hand-foot-and-mouth disease) is a kind of prevalent acute infectious for children, which is caused by intestinal viruses, and the main feature is fever and rash, herpes, or herpes angina in hands, feet, mouth and some other part of the body. The pathogens of HFMD is gastro-intestinal virus,including echovirus, Coxsackie virus A Group and EV71, among them, the HFMD which is caused by EV71 may be complicated by aseptic meningitis, brainstem encephalitis, neurogenic pulmonary edema, acute flaccid paralysis, and myocarditis and so on. It endanger infants and young children'life and health seriously, so it is compared to the "polio" in 21 century. Thus seeking the early warning and diagnosis indicators for progression of severe HFMD becomes a big problem. Neuron-specific enolase (NSE) is a kind of neuron-specificγsubunit-containing sugar alcohols lyase, Nerve cells collapse when the brain was damaged, then the enzyme spilled into the cerebrospinal fluid and make the content elevate to a higher level. Many scholars regard the NSE levels in cerebrospinal fluid as a specific target for determinating neuronal damage. Besides, it reported that the increasing of total protein in cerebrospinal fluid associated with the disease,which can be used to observe the extent and efficacy of infection. Normal cerebrospinal fluid is mainly albumin, and the protein content less than 1% of plasma protein's. CSF protein content may have varying degrees of increased when the central nervous system is lesion. There are few reports about that whether the content of protein and NSE levels in CSF can indicate the development of the HFMD's statement. In this article, the cerebrospinal fluid protein and NSE levels in 307 cases of children with severe HFMD were determined, combined with other clinical parameters in order to explore its early warning and diagnosis of clinical significance. Methods:The 307 cases of children with HFMD were divided into A, B, C three groups. According to the diagnostic criteria of severe cases in The Ministry of Health issued a "Diagnosis and treatment for HFMD Technical Guide For health care clinics", that is whether the nervous system affected, and other complications. Group A were the group nervous system unaffected; Group B were the group with nervous system affected, but without other systems'hurt; Group C were the group with nervous system affected and Cardio-pulmonary system damage. In the acute phase duration 1~3d, selected children were examined by lumbar puncture and 3~5mL cerebrospinal fluid specimens were taken. And the CSF normal, biochemical (sugar, chloride, protein) were examined . The other 1mL specimens were taken and placed in -20°C low temperature refrigerator for the test of NSE, meanwhile, Routine blood test, blood glucose, and the etiology of myocardial enzymes were examined. The results were analyzed statistically by SPSS16.0 statistical software. The results were expressed as mean±Standard deviation( x±s). Measurement data between the two groups for homogeneity of variance test. P>0.1was regard as the homogeneity of variance,The average number of each group were analyzed by one-way ANOVA. SNK-q test were used in the comparison between the two groups, multipre linear regression analysis was used to porcess indexes in the measurement data,χ2 test were use in count data. The results of the comparison with P<0.05 was considered to be statistically significant.Results:1 the onset age and genderSevere always occurred in children in the age less than three years (89.90%), male 194 cases (63.19%), female 113 cases (36.81%).2 clinical symptoms and signs2.1 most of the children with severe HFMD had a sustained fever (81.06%), and the type are mostly continued fever; Fever peak and fever continued days'statistical data were compared in group A, group B, group C ,and the result was no statistical significance, P>0.05, there was no contrast in each group. after theχ~2 test in The rash of each group,χ~2 = 13.184, P>0.05, no statistical significance, it tells that there is no contact in the number of skin rash and the statement of the disease, limbs Jitter (75.57%), apathetic (63.52%) are the most common manifestations.2.2 the respiratory rate of group A, group B, group C were 25.50±2.34 beats / min, 30.29±5.65 beats / min, 32.74±7.09 beats / min separately, the comparisons showed:, Respiratory frequency in Group A and Group B increased faster (P<0.05) than that in Group C; Respiratory rate change in Group B and C was not significant (P> 0.05). it tells that respiratory rate of HFMD sufferer with nervous system affected is faster than that of those without nervous system involvement.2.3 heart rate, blood pressure comparisons in group A, group B, group C showed: the values in heart rate, blood pressure in group C was higher than that in A group(P<0.05), heart rate blood pressure changes in group B and group A was not significant (P>0.05), it tells that the value of heart rate and blood pressure in sufferers with heart and lung damage are higher than the other two groups.3 assistant examination3.1 Group A and Group B were merged to be the group with nervous system affected compare to Group A in the rate of EV71, after theχ~2 test,χ~2 = 9.455, P<0.01, it had statistical significance. It tells that the cases of EV71 infection HFMD sufferer with central nervous system damage are multitude and the disease condition is serious.3.2 the blood glucose values in group A, group B and group C were: 5.57±0.73 mmol / L, 6.31±1.26 mmol / L, 8.32±3.65 mmol / L, the comparisons showed: the blood glucose in group C was somewhat higher than that in group A and group B (P<0.05); Group A and group B were not significantly different(P>0.05). It tells that the value of blood sugar in sufferers with central nervous system and heart-lung damage are higher than the other two groups.3.3 the peripheral blood WBC values in group A, group B and group C were: 10.08±4.23×10~9 / L, 10.80±4.63×10~9 / L, 12.53±5.61×10~9 / L, the comparisons showed: the peripheral WBC values in group C was somewhat higher than that in group A and group B (P<0.05); Group A and group B were not significantly different (P> 0.05). It tells that the peripheral blood WBC value in sufferers with central nervous system and heart-lung damage are higher than the other two groups.3.4 The statistical results of three groups in the value of CSF WBC, lymphocyte values, serum CRP values, serum CK-MB values, serum LDH value showed that: it was no statistical significance (P> 0.05), there was no contrast in each group.3.5 the cerebrospinal fluid protein values in group A, group B and group C were: 0.176±0.018 g / L, 0.394±0.161 g / L, 0.465±0.150 g / L, the cerebrospinal fluid protein values in group B and group C was somewhat higher than that in group A, The difference was statistically significant (P<0.05); Group B and group C were not significantly different (P>0.05), it was not statistically significant. It tells that cerebrospinal fluid protein value in sufferers with central nervous system and heart-lung damage are higher than the other two groups.3.6 The multiple linear regression analysis for CSF protein and respiration, heart rate, blood pressure, blood glucose, peripheral WBC F = 10.037, P = 0.000, the fitting multiple linear regression equations have statistical significance.3.7 the NSE values in group A, group B and group C were 0.012±0.001 ng / ml, 0.085±0.166 ng / ml, 1.123±2.444 ng / ml, the comparisons showed no statistical significance (P>0.05), the groups were no contrast.Conclusion:1. Monitoring HFMD sufferers'breathing, heart rate, blood pressure can help to find severe disease cases more early.2. The increase of white blood cells and the rise of blood glucose,CSF protein are important symptom in HFMD sufferers with Nervous system affected and heart-lung damage, it isimportant references index to indicate the possibility of sufferers'deterioration and elevation.3.the cases of EV71 infection HFMD sufferer with central nervous system damage are multitude and the disease condition is serious.4. the number of skin rash, fever peak and fever continued days have no obvious relationship with the statement of the disease.5. NSE in sufferers'CSF has no obvious relationship with the statement of the disease, research of big sample and muti-centre is needed. |
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