Analysis Of Inflammatory Cytokines And Biochemical Parameters And Their Clinical Significance In Children With Hand Foot And Mouth Disease Caused By Enterovirus 71 Infection

ObjectiveThe levels of inflammatory cytokines and biochemical indicators in peripheral blood of children with hand foot and mouth disease(HFMD)caused by enterovirus71(EV-71)may be closely related to the disease progression.In this study,peripheral blood WBC count,interleukin-6(IL-6),interleukin-10(IL-10),immunoglobulin(IgG、IgM、IgA),complement(C3、C4)and myocardial enzyme spectrum and blood glucose levels were analyzed in children with HFMD(EV-71),the correlation between the White Blood Cell Count in the brain crest fluid and the inflammatory factors and biochemical indexes in peripheral blood was analyzed,aiming to explore their clinical significances in the course and severity of HFMD and to provide evidence for diagnosis and treatment of HFMD.MethodsReal-time fluorescence quantitative PCR(QRT-PCR)was used to determine enterovirus types in children with HFMD.The peripheral blood samples of 267 children infected with EV-71,including mild,severe and critically ill patients,and brain crest fluid specimens from 77 cases of them infected with central nervous system and the peripheral blood samples of 52 healthy children were collected.Mindray blood analyzer were used for WBC count.BD FACS Canto flow cytometer for the levels of IL-6 and IL-10.Hitachi 7600 automatic biochemical analyzer for myocardial enzyme spectrum,blood glucose,immunoglobulin and complement detection.The white blood cells in the cerebrospinal fluid were directly counted by capillary pipette.ResultsI Compared with the healthy control,the levels of IL-6,IL-10,GLU and WBC count in the peripheral blood of children with HFMD caused by EV-71 infection were significantly increased.Plasma levels of IL-6,IL-10,GLU and WBC count in severe patients were significantly higher than that in mild patients.Plasma levels of IL-6,IL-10,GLU and WBC count in critical patients were significantly higher than that in mild patients.Plasma levels of IL-6,IL-10,GLU and WBC count in critical patients were significantly higher than that in severe patients.Ⅱ Compared with the healthy control,there was no significant difference in the levels of complement C3 and C4.In the HFMD caused by EV-71 infection,there was no significant difference in the levels of complement C3 and C4 among the mild patients,critical patients and severe patients.Ⅲ Compared with the healthy control,the levels of IgG and IgM in the peripheral blood of EV-71 infected children with HFMD were significantly decreased.There was no significant difference in the level of IgA.Levels of IgG and IgM in severe patients were significantly lower than that in mild patients.Levels of IgG and IgM in critical patients were significantly lower than that in mild patients.Levels of IgG and IgM in critical patients were significantly lower than that in severe patients.In the HFMD with EV-71 infection,there was no significant difference in the level of IgA among the mild patients,critical patients and severe patients.Ⅳ Compared with the healthy control,the levels of LDH,HBDH,CK and CK-MB in the peripheral blood of EV-71 infected children with HFMD were significantly increased.Levels of LDH and CK-MB in severe patients were significantly higher than that in mild patients.Levels of LDH and CK-MB in critical patients were significantly higher than that in mild patients.Levels of LDH and CK-MB in critical patients were significantly higher than that in severe patients.Levels of HBDH and CK in critical patients were significantly higher than that in mild patients.Levels of HBDH and CK in critical patients were significantly higher than that in severe patients.There were no significant differences in the levels of HBDH and CK between the severe patients and the mild patients.V There was a positive correlation between the number of white blood cells(WBC)in cerebrospinal fluid(CSF)and the levels of IL-10 and IL-6 in peripheral blood in children with central nerve injury caused by EV-71 infection,there was no significant correlation between LDH,HBDH,CK,CK-MB,IgG,IGM,Glu and WBC.ConclusionsCompared with the healthy control,the levels of IL-6,IL-10,WBC count,GLU,LDH,HBDH,CK and CK-MB in the peripheral blood of EV-71 infected children with HFMD were significantly increased.The levels of IgG and IgM were significantly decreased.These data suggest that EV-71 virus can cause inflammation and myocardial cell injury after infection,which is beneficial to shorten the diagnosis time and make treatment plan in time.As the disease become more severe,the levels of IL-6,IL-10,WBC count,GLU,LDH,HBDH,CK and CK-MB in peripheral blood of EV-71 infected children with HFMD were progressively increased,consistent with the severity of the disease.The levels of IgG and IgM decreased gradually with the aggravation of the disease.The results suggest that the above indexes are correlated with the progression of HFMD.Dynamic monitoring of its content in children with EV-71 infection can reflect the immune status of children from the side.It is beneficial to evaluate the dynamic condition of children and provides a reliable basis for early diagnosis and treatment of critically ill children.The number of white blood cells in the brain crest fluid of the patients with severe and critical central nervous system injury was positively correlated with IL-6 and IL-10 in peripheral blood,early diagnosis and early treatment should be carried out by combined detection of brain crest fluid and peripheral blood IL-6 and IL-10,combined with clinical doctors’ experience and clinical features.