Clinical Significance Of Detection Of Myocardial Enzymes And C-Reactive Protein In Children With Hand-Foot-and-Mouth Diseaseand Related Factors

BackgroundHand-foot-mouth disease(HFMD)is an infectious disease caused by a variety of enterovirus infections,and the most common types of virus infections are the newenterovirus71(EV71)and coxsackievirus A Group 16(CoxA 16).There are different degrees of myocardial damage some children when foot and mouth disease virus infection.In the early stages of myocardial damage,myocardial enzymes will have varying degrees of elevation,which can be used as early warning of disease progression.Traditional myocardial enzymes include aspartate transaminase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase mbisoenzyme(CKMB),and hydroxybutyrate dehydrogenase(HBDH).C-reactive protein(CRP)is an acute phase response protein,when the HEMD in children with myocardial damage,the CRP increased rapidly,which is the embodiment of cell inflammatory response.Meanwhile,the CRP can also assess the activity of inflammatory diseases,and determine the prognosis.Therefore,the determination of myocardial enzymes and CRP in the early stage of the HFMD has a very important value in the prevention and treatment of the disease.ObjectiveIn this study,we wanted to determine the levels of myocardial enzymes and CRP in the study subjects,and combined with other clinical and laboratory indicators to explore the clinical significance of myocardial enzymes and CRP in the early warning and diagnosis of HFMD.MethodsBased on the theory of case-control study,we collected about 80 cases(including EV71 infection and CoxA16 infection)and 80 controls in the Jining Infectious Diseases Hospital.The controls came from the outpatient department who were diagnosed without the HFMD but with skin irritation and foot rash.The patients were divided into EV71 infection group and CoxA16 infection group according to the different types of infection virus.Subjects were examined by myocardial enzymes and CRP,and other related examination,children treated 4 to 5 days after the review of myocardial enzymes.All the data were recorded in Excel?and the SPSS19.0 statistical software was used for statistical analysis.Qualitative data was represented as rate or constituent ratio,and the quantitative data was represented as mean � standard deviation(x�s).All data were tested for normality,,if the data were in a normal distribution,the t test was used;if the normal distribution was not met,the rank-sum test is used.Comparison of the results with P<0.05 was considered statistically significant.ResultS1.Comparison of the results of myocardial enzymes before treatment in the case and control groupThere were significant differences in AST,LDH,CK,CKMB and HBDH between the two groups(P<0.05).The five kinds of myocardial enzymes in the case group were significantly higher than the control group.The levels of AST,LDH and HBDH in the case group were higher than those in the control group(about 2 folds),and the levels of CK and CKMB in the case group were higher than those in the control group(about 5 folds).The change of CK and CKMB in the myocardium of the case group was more obvious.2.Comparison of the results of myocardial enzymes in children with different types of virus infectionThere were significant differences in AST and CKMB between EV71 infection group and CoxA16 infection group(P<0.05).There was no significant difference in LDH and HBDH between the two groups(P>0.05).The expression level of the two enzymes was not correlated with the type of virus infection.3.Comparison of the results of myocardial enzymes after treatment with different types of virus infectionThe levels of AST,LDH,CK,CKMB and HBDH before and after treatment in EV71 group were statistically significant(P<0.05).After the treatment,the levels of AST decreased by 31.16%,the levels of LDH decreased by 33.69%,the levels of CK decreased by 47.30%,the levels of CKMB decreased by 54.98%,and the levels of HBDH decreased by 22.77%.The results indicated that the treatment was effective in reducing the levels of AST,LDH,CK,CKMB and HBDH in the children with EV71 infection.The levels of AST,CK,LDH,CKMB and HBDH before and after treatment in children with CoxA 16 infection were statistically significant(P<0.05).After the treatment,the levels of AST decreased by 27.55%,the levels of LDH decreased by 30.49%,the levels of CK decreased by 47.61%,the levels of CKMB decreased by 36.89%,and the levels of HBDH decreased by 20.34%.The results indicated that the treatment was effective in reducing the levels of AST,LDH,CK,CKMB and HBDH.4.Comparison of clinical characteristics of children with different types of virus infectionThere was significant difference in the duration of clinical fever between EV71 infection group and CoxA 16 infection group(P<0.05),suggesting that the lasting time of fever of EV71 infection group was longer than that of CoxA 16 group.5.Comparison of CRP Results in Children with HFMDThe CRP level in the case group was significantly higher than that in the control group(P<0.05).The CRP level in the case group was 5.7 folds higher than that in the control group,which indicated that there may be a inflammatory reaction in children with HFMD.There was significant difference in CRP level between EV71 infection group and CoxA16 infection group(P<0.05),suggesting that CRP level was associated with the type of virus infection.6.Comparison of blood samples from children with different types of virus infectionThere were significant differences in the levels of white blood cells between EV71 infection group and CoxA16 infection group(P<0.05).The count number of neutrophils,lymphocytes,erythrocytes,hemoglobin and platelet were not statistically significant(P>0.05).7.Analysis of myocardial enzyme influencing factorsThe results of Logsitic regression analysis showed that,after adjusting the variables,the levels of CRP(OR=2.206,95%CI=1.155-4.213)and the fever(OR=21.082,95%CI=1.948-228.170)were the impact factors of CK;meanwhile,the levels of CRP(OR=2.865,95%CI=1.273-6.444)and the fever(OR=59.756,95%CI=3.335-1070.564)were also the impact factors of CKMB.Conclusion1.The levels of myocardial enzymes and CRP in children with HFMD are significantly increased,especially the levels of CK and CKMB,which suggest that the children with HFMD have a risk of myocardial damage2.Treatment for HFMD may have a certain effect in decreasing the levels of myocardial enzymes.3.CKMB and AST were associated with EV71 virus infection.CK,LDH,HBDH levels were not associated with the type of virus infection.4.Fever is an important factor affecting the increase of CK and CKMB in children with HFMD.After admission to children with HFMD,the fever should be controlled in time to prevent the occurrence of myocardial damage.