Analysis Of Correlation Between Clinical Features And S100B,NSE,Cranial MRI From The Children With Severe Hfmd Stage 2

Objective: To investigate the correlation between clinical characteristics of children with severe stage 2 HFMD and cranial MRI imaging changes,astroglia derived protein(S100B)and neuron-specific enolase(NSE)levels,to lay a foundation for accurate recognition and its early intervention in severe HFMD,and effectively control the progress of the disease and reduce the mortality of the patients.Methods: 95 cases of severe HFMD in the Department of Pediatrics,affiliated Our hospital from October 2016 to March 2018 were selected as severe group.A total of 96 cases of hand,foot and mouth disease were randomly selected as normal group.90 healthy children in the Department of Child Health Care in our hospital were set as the control group.Clinical data of patients were collected.Serum NSE and S100 B levels in all patients and the control group were determined by enzyme linked immunosorbent assay(ELISA).MRI examination of the head was performed in the severe group.SPSS20.0 software was used for statistical analysis.Results:(1)The positive rates of enterovirus 71(EV 71)and Cox sachie virus(Cox A l6)were 62.1% and 10.5%,respectively,and the mild group was 33.3%.25%,the difference between the two groups was statistically significant(P<0.01).(2)The rate of appearance in the temperature of the children with severe group is 39.0 ℃ or more,the body shakes,vomits,weakness of limbs in severe group were 91.5%,100%,4.2%,7.3%;Compared with the normal group,the rate in normal group were 56.2%,0%,0%,4.1%,the difference of the rateof appearance that the temperature is 39.0 ℃ or more,the body shakes,vomits has statistically significance(P < 0.01 or P < 0.05).The mean length of hospital stay in the severe group was(5.11± 1.35)d,and that in the normal group was(3.11± 1.32)d.The mean length of hospital stay in the severe group was higher than that in the normal group,and the difference has statistically significant(P < 0.01).(3)Compared with the normal group,white blood cells,percentage of neutrophils,alanine aminotransferase,creatine kinase isozyme,blood glucose and hypersensitive c-reactive protein in the severe group were more significantly different(P < 0.01).(4)The contents of S100 B in serum of the severe group,the normal group and the control group were(1.79 ±0.30),(0.33 ±0.11)and(0.15± 0.04)ng/ml,respectively.The content of S100 B in serum of severe group was significantly higher than that of normal group and control group(P < 0.01).The content of S100 B in serum of normal group was significantly higher than that of control group(P < 0.01 or P < 0.05).(5)The serum NSE levels in the severe group,the normal group and the control group were(53.27± 14.91),(6.76 ±3.49)and(6.35 ±3.44)ng/ml,respectively.The serum NSE level in the severe group was significantly higher than that in the normal group and the control group(P < 0.01).There was no significant difference in NSE level between the the normal group(P > 0.05).(6)There were 52 cases of head MRI prompted parenchymal damage image in severe group,,accounting for 52%,single or multiple abnormal signals of chidren with parenchymal damage of brain MRI can be seen(T1WI low signal,high T2 WI signal).There were also 30 cases of single parenchymal damage,22 cases of multiple parenchymal damage,injuring to basal ganglia,thalamus,and brain stem areas.(7)The follow-up showed that 12 cases of severe stage 2 group developed to more than stage 3,including 11 cases of stage 3and 1 case of stage 4.Abnormal changes of brain MRI were found in all children with stage 3and 4(8 cases with multiple brain parenchyma lesions and 2 cases with single brainstem lesions).The levels of NSE and S100 B in 12 children with stage 3 and 4 were controlled in time,but the values in 83 patients with stage 2 were significantly higher than those in patientswith stage 2 without any further progress(P < 0.01),and there was no significant difference between the two groups(P < 0.05).Conclusion:(1)EV71 is the main pathogen causing severe stage 2 of hand,foot and mouth disease.(2)The temperature of 39.0 ℃ or more,body shaking,vomiting,white cells increasing,allergic-a significant rise in the level of C-reactive protein level significantly increased early stage clinical observation of the second stage of children with severe disease of foot and mouth disease has certain guiding and reference value.(3)Serum levels of S100 B and NSE have certain guiding and reference value for early identification of HFMD severe stage(stage 2).(4)The proportion of MRI brain parenchymal lesions in children with severe hand,foot and mouth disease is relatively high.The levels of MRI combined with NSE and S100 B are highly sensitive and clinically valuable for assessing the condition of hand,foot and mouth disease and predicting the progress of hand,foot and mouth disease and prognosis.