The Clinical Significance Of Inflammatory Cytokines In Severe HFMD With EV71

Background: HFMD is a kind of children’ infectious diseases in which rash appear in hands, feet, intraoral, crissum. The mild patients have fever and other non-typical symptoms in addition to rash. Symptoms found in some children deteriorate rapidly, and they have symptoms such as respiratory and circulatory failure. During recent years, the cases of hand foot mouth disease has gradually increased, which has become a public safety issue in our country. Some scholars found that EV71 is the main pathogenic of HFMD and the pathogenesis related to inflammation.MCP1, HMGB1, IL-1β, IL-10, IL-18 play an important role in many inflammatory diseases, but the clinical significance is rarely reported.Objective: To explore the clinical significance of MCP1, HMGB1, IL-1β, IL-10, IL-18 in severe HFMD with EV71.Methods: Records of HFMD patients from children’ hospital of Hunan Province from March to August, 2014 are collected according to the Treatment guidelines, and the laboratory-confirmed pathogen is EV71. Patients are categorized into stage 2 to 5 by condition. Blood sample are collected within 24 hours and they are put it into EDTA anti-coagulated tube using ELISA to detect inflammatory cytokines HMGB1, IL-1β, IL-18, IL-10, MCP1, and collect clinical data. The data is calculated with statistical software SPSS19.0.Results:(1)102 cases of EV71 HFMD are included in the research. Stage 2 have 22 cases, aging 6 month to 5 years old. 36 cases deteriorate into stage 3 from stage 2, and cured cases was 41. Stage 3 have 16 cases, aging 6 month to 4 years old. 7 cases deteriorate into stage 3 from stage 2, and cured cases was 9. Stage 4 have 9 cases,aging 6 month to 4 years old.The death cases was 14, and cured cases was 81.(2) Comparing normal group and stage 2 group, stage 3group,stage 4group, it is found that the levels of MCP1,HMGB1,IL-1β, IL-18, case group were significantly higher than normal group,and the more serious a patient’s condition is, the higher level MCP1,HMGB1,IL-1β,IL-18 there will be. No difference is found in Stage 3 group and Stage 4 group.(3)Comparing the level of HMGB1 between deteriorative group and cured group in stage 2, it is found that the former one higher than the latter one, but there is no difference in terms of level of MCP1,IL-1β,IL-10,IL-18. Comparing the level of HMGBI between deteriorative group and cured group in stage 3, it is found that the former is higher than the latter, and there is no difference as to level of MCP1、IL-1β、IL-10、IL-18 between two group.(4)Comparing the level of HMGB1 between death group and survival group in stage 4, it is found that the former one higher than the latter one. Comparing the level of IL-10 between death group and survival group in stage 4, it is found that the latter one higher than the former one, but there is no difference in terms of level of MCP1,IL-1β,IL-18 between two groups.(5)In a dynamic observation of stage 2 it is found that the level of IL-10 remains the same between stage 3group and stage 4group.With the aggravation of patient’s condition and the level of MCP1, HMGB1, IL-1β,IL-18 increased.Conclusion:(1)The level of pro-inflammatory cytokines MCP1, HMGB1, IL-1β, IL-18 and inhibiting inflammatory cytokine IL-10 in the blood changes follow the patient’s condition, which indicates that they play an important role in the inflammation process in EV71 HFMD.(2) HMGB1 may be able to predict the outcome of EV71 HFMD.