Observation Of Serum NE、COR、ACTH Levels Of Children With Hand Foot And Mouth Disease And Analysis Of Risk Factors About Severe Cases

ObjectiveTo observation the serum levels of norepinephrine(NE), cortisol(COR), adrenocorticotrophic hormone(ACTH) in children with hand, foot and mouth disease(HFMD) to discuss the three indicators’ clinical value for judging the illness severity and evaluating prognosis of hand foot and mouth disease.Also analyze the clinical characteristics of children with severe hand,foot and mouth disease and explore the risk factors of severe cases.MethodsSelect 100 children with HFMD hospitalized in our hospital from April to October,2014. According to the illness severity degree, these children can be divided into three groups: common type group(40 cases),severe type group(37cases)and critical type group(23cases).Meanwhile, another 30 healthy children(under five ages) were enrolled as the control group over the same period. Blood samples of these children were collected at the next morning eight o’clock after they were admitted to our hospital. Then retained the 3ml blood in vacuumed and sterile blood-collection tube, centrifugated to get supematant and preserved the supermatant in-20 ℃refrigerator.Then measured the serum levels of NE,COR and ACTH by using ELASE method.The blood specimen collection time of other laboratory test index keep pace with the experimental blood specimen collection time. Collect and analyze all cases’ confirmation data. Using SPSS19.0 statistical package to analyze the data. And α=0.05 was the inspection level.Results1.The levels of serum NE,COR and ACTHThe levels of serum NE were respectively 165.93 ? 30.55ng/L,197.62 ? 23.99ng/L、232.43 ? 24.13ng/L、256.75 ? 19.05ng/L in control group and the three other case groups; The levels of serum COR were respectively 97.33 ? 13.96ug/L、139.25 ? 21.28ug/L、183.83 ? 16.40ug/L in the four groups;The levels of serum ACTH were 42.71 ? 10.60ng/L、56.12 ? 9.83ng/L、69.31 ? 7.28ng/L、79.58 ? 8.66ng/L respectively in the four groups. There were statistical differences among the four groups with the three indicators.The differences between two groups had statistical significance. It suggested that the NE,COR and ACTH levels in children with hand, foot and mouth disease were higher than healthy children and the levels of three indicators were increased with the disease aggravate. That is to say,the serum levels of critical type were highest significantly, followed by sever and common types.2.Single factor analysis results(1)The differences of years old,gender composition,fever,the rash distribution, WBC,CRP,CK, CKMB and the cerebrospinal fluid leukocyte of the three groups had no statistically significance.(2)Positive rate of EV71 :the statistic difference of positive rate of EV71 between common cases and severe cases. Breathing and heart rate: the breathing and heart rates were higher than normal group and the differences of each two groups were statistically significant. Blood pressure:The statistical difference between severe and critical groups was significant. Blood glucose :Blood glucose of critical group was higher significantly than that of severe group which was higher than normal group.The statistical differences of groups were significantly. Nervous system symptoms:All of the severe and critical cases had nervous system symptoms.Spiritual malaise(56.67%),limb shaking(50.00%) and sleepiness(48.33%) had a higher propotion of all the nervous system symptoms.3.Correlation analysisThe levels of NE of cases children were positively correlated with breath rate,heart rate and blood pressure.The correlation coefficient were respectively r=0.502,r=0.512,r=0.481,P<0.05. Also,the COR levels of cases were positively correlated with the levels of blood glucose and ACTH.The correlation coefficient were respectively r=0.651,r=0.767.P<0.05.4.Logistic regression analysisThe logistic regression analysis showed that : breath rate >40 beats/min and blood glucose>9mmol/L were the risk factors that the children with hand foot and mouth disease progress to severe cases.Conclusions1.The levels of serum NE、COR and ACTH of children with hand foot and mouth disease were higher.The heavier of the disease, the worse prognosis and the levels of the three indicators can judge the illness severity early and evaluate prognosis of hand foot and mouth disease.2.The serum NE,COR and ACTH of children with hand foot and mouth disease may be involved in the disease progression.3.Breathing rate >40 rates/min and blood glucose>9mmol/L were the risk factors of the general cases progress to sereve cases of children with hand foot and mouth disease.