| Objectives This article focus on factors between ordinary group and children with severe Hand-foot-mouth disease caused by EV71 infection.Through this study,we observed the changes of laboratory test indicators to analyze the relationship between the human immune system and disease progression.So that we can look for early warnings for the development of children's diseases,to improve the cure rate of severe HFMD disease and the prognosis.Methods A total of 249 inpatients who first diagnosed common type of EV71 HFMD from June to September of 2017 in Children's Hospital of Hebei Province were selected as the study subjects.After communicating with children's family members,we took children's peripheral blood when they were admitted to the hospital.The 249 children were divided into two groups according to the progress of the follow-up conditions:the ordinary group was those who were cured without any complications(32cases),Severe group was those who developed into severe HFMD(the rest 217 children).We used flow cytometry to detect the changes of lymphocyte subsets(CD3~+T cells,CD4~+T cells,CD8~+T cells,CD4~+/CD8~+)and ELISA was used to detect changes in inflammatory factors such as interleukin-1?,interleukin-6,interleukin-10,etc.We collected their clinical indicators including leukocyte count,myocardial enzymes,immunoglobulin A,immunoglobulin G,and immunoglobulin M during hospitalization.Datas such as gender,age,and highest temperature before admission were also collected.We used SPSS22.0 software to analyze the statistical differences between the two groups.Independent data t-test analysis was used for measurement datas,Chi-square test was used for count datas,P<0.05 was considered statistically significant.A multivariate linear regression model was used to analyze factors associated with disease progression.P<0.05 was considered statistically significant.Results 1 Gender and maximum body temperature:There were 81 cases of female and 136 male children in the 217 cases of ordinary group with a sex ratio of 1.68:1;There were 10 cases of female children and 22 cases of male children in 32 cases of severe group with a sex ratio of 2.20:1;The difference in gender ratio between the two groups had no statistically significant(P>0.05).The average of highest body temperature of the 217 children in the ordinary group was 38.4°C,and the average of highest body temperature of the 32 children in the severe group was 39.1°C.The difference between the two groups was statistically significant(P<0.05).2 The main subpopulation of T lymphocytes:The mean of CD3~+T cell subsets in the severe group were 2835/ul and the CD3~+T cell subsets were significantly lower than those in the ordinary group with an average of 4811/ul.The mean of CD4~+/CD8~+in the severe group was 1.20 and the mean in the ordinary group was 1.44.Compared with the significant decrease,the difference between the two groups was statistically significant(P<0.05).Compared to the ordinary group,CD4~+and CD8~+in the severe group had different degrees of reduction,but there was no significant difference between the two groups(P>0.05).3 Immunoglobulin:The IgA antibody concentration in the severe group was 0.46g/L,which was lower than the 0.69g/L in the ordinary group.The concentration of IgM in the peripheral blood of the severe group was 1.07g/L,which was higher than 0.81g/L in the ordinary group.The differences between the two were statistically significant(P<0.05).The IgG concentration in the severe group was 5.39g/L,which was lower than the 5.63g/L in the ordinary group,but the difference was not statistically significant(P>0.05).4 Myocardial enzymes:The average concentration of Creatine kinase in children with severe disease was77.90U/L,which was slightly higher than 67.74U/L in the ordinary group.The mean concentration of creatine kinase isoenzyme in severe group was 25.71U/L,which was slightly lower than the average concentration in the ordinary group of 26.44U/L.There was no significant difference between the two groups(P>0.05).5 Inflammatory factors:The average concentration of IL-1?in peripheral blood of the severe group was 1175.70pg/ml,which was slightly lower than the mean concentration of the ordinary group of 1249.00pg/ml.The mean concentration of IL-10 in the severe group was 66.25?g/ml,which was slightly higher than that in the ordinary group of 63.35pg/ml.But there was no significant difference between the two groups(P>0.05).The average concentration of IL-6 in the peripheral blood of the severe group was higher than that of the ordinary group(48.36pg/ml and 43.25pg/ml,respectively).The difference between the two groups was statistically significant(P<0.05).6 Statistically significant indicators(CD3~+,CD4~+/CD8~+,IgM,IL-6)were combined into a logistic model.The results showed that CD3~+,IL-6 and Ig M may be predictors of disease progression.Conclusions 1 The levels of CD3+and CD4+/CD8+in peripheral blood of severe HFMD infants decreased,so that the cellular immune function was inhibited and the function of helper T cells was relatively insufficient.2 In the early time of disease,the concentration of IgA decreased in peripheral blood but he concentration of IgM increased,that means the humoral immune function was disordered.3 In the early stage of disease,IL-6 emerges firstly,which can be used as an important indicator to predict the processing of disease. |
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