Study The Early Warning Of Severe Hand, Foot And Mouth Disease Caused By EV71 In Suzhou

Objective: To analyze the risk factors of severe hand,foot and mouth disease(HFMD)caused by EV 71 from clinical manifestation,laboratory examination and immune function,and to explore the diagnostic value of IFN-? in severe EV71-induced HFMD.Methods : 1.A total of 453 cases with EV71-induced HFMD hospitalized in Children's Hospital of Soochow University from January 2015 to December 2016 were divided into two groups.155 cases with complications of central nervous system were in severe group and 298 cases with no complication were common group.Retrospectively analyze the two groups of children's history data,blood routine,biochemical indicators and immune function to find the different indicators.2.Collect the peripheral blood samples of 80 cases children with EV71-induced HFMD who were hospitalized in the Children's Hospital of Soochow University from April 2016 to September 2016,40 cases in the severe group and 40 cases in the common group.The expression of IFN-? in plasma was detected by ELISA method,and its blood routine,blood biochemistry and immune function were analyzed.The sensitivity and specificity of IFN-? and its differential indexes in the diagnosis of severe HFMD caused by EV71 were analyzed by receiver operating characteristic curve.Results:1.The main onset age of EV71-induced HFMD is 1-4 years old,male was more than female,and there were more children living in urban and rural areas.2.The febrile peak value was higher in the severe group,the duration of fever was longer than that in the common group,vomiting,startle,wobble of the hands and feet,lethargy,oliguria were more frequent(P < 0.01),but there was no significant difference between the two groups in the symptoms of convulsion,irritability,apastia and cough(P>0.05).3.The counts of leucocytes and the neutrophils in severe group was higher than that in common group(P < 0.05),and the counts of lymphocyte and CRP were lower(P < 0.05).The expression of IgA and IgG in severe group was higher than that in common group(P < 0.01),while the counts of CD3+,CD3-CD(16+56)+,CD19+CD23+ and the ratio of CD4+/CD8+were lower.The expression of CD3+ CD4+ in the severe group was lower than that in the common group,but there was no significant difference(P=0.05).There was no significant difference in the counts of CD3-CD19 + between the two groups(P > 0.05).4.The levels of CK-MB and LDH in the severe group was higher than that in the common group,but the levels of PA and IFN-? were lower than those in the common group(P < 0.01).Receiver operating characteristic curve analysis: Taking 8.76pg/ml as the cut-off level the sensitivity of IFN-? in the diagnosis of severe EV71-induced HFMD was 97.5%,and the specificity was 82.5%.Using 3.7U/L as the cut-off point,the sensitivity and specificity of CK-MB in the diagnosis of severe EV71-induced HFMD were 70% and 97.5% respectively.Using 363.85U/L as the cut-off point,the sensitivity and specificity of serum LDH in the diagnosis of severe EV71-induced HFMD was 70% and 97.5% respectively.Taking 175mg/L as the cut-off point the sensitivity and specificity of PA in the diagnosis of severe EV71-induced HFMD were 75% and 92.5% respectively.Conclusions:1.Severe HFMD caused by EV71 in Suzhou area is characterized by long febrile time,convulsions,limb jitter and other nervous system symptoms.The counts of white blood cells and neutrophils increased obviously,the damage of myocardium is easy to occur,liver and kidney damage is rare,the humoral immunity is hyperactive and the cellular immune function is decreased.2.The level of plasma IFN-? may be a good index for warning severe EV71-induced HFMD while CK-MB,LDH and PA have certain value in early warning of severe EV71-induced HFMD.