Exploration Of The Serum Level Of Cytokines And Immunoglobulins In Children Patients With Hand, Foot And Mouth Disease

Objectives:Hand-foot-mouth disease(HFMD) is one of the common infectious diseases in infants, mostly caused by two kinds of intestinal viruses- coxsackie virus A16 (CoxA16) and enterovirus 71 (EV71).HFMD can develop fever, hand, foot skin herpes and oral mucosal ulcers. HFMD is a kind of self-limiting disease.The majority of HFMD patients have good prognosis,few of them will develop myocarditis, pulmonary edema and aseptic meningoencephalitis which can lead to death. In recent years, the domestic mortality of HFMD increased in some areas. How to evaluate the risk of occurrence of severe events early and give correctly and timely intervention is essential for improving disease prognosis and increasing the survival rate.Nowadays, White blood Cell Count(WBC), Glucose(Glu), and C-Reactive Protein(CRP) are often used to diagnose HFMD. Interleukin-1β(IL-1β),Tumor Necrosis Factor-a(TNF-a),Interleukin-6(IL-6) and Interleukin-10(IL-10), which have many biological functions, take part in the progress of systemic inflammatory response syndrome (SIRS).The levels of these cytokines can reflect the inflammatory response and provide evidence for clinical diagnosis. The levels of IgM, IgG and IgA may reflect a certain degree of humoral immunity in some degree. In this research, the levels of IL-1β,TNF-a,IL-6 and IL-10 and IgM, IgG, IgA were detected in HFMD patients to explore the relations between these serum cytokines and immunoglobulins, and to investigate the relations between these serum cytokines and immunoglobulins in the progress of HFMD. Methods:Totally 47 children with HFMD from May to July, 2010 in the First People's Hospital of Chuzhou were chosen.Among them,there were 24 male cases and 23 female cases,and the average age was 22.57±9.13months. All patients were diagnosed and condition assessed under《HFMD diagnosis and treatment guidelines (2010 edition)》issued by the Ministry of Health Office. The cases were divided into the general group(25 cases) and severe group(22 cases) according to critical degree. Serum IL-1β, TNF-a,IL-6, IL-10 were analysed by the method of enzyme-link immunosorbent assay(ELISA) and serum IgM,IgG,IgA,C3,C4 by the method of immunoturbidimetric assay respectively. The serum levels of Glu and CRP were evaluated by TOSHIBA-40FR. WBC was measured by ABX Pentva 60. At the same time, 10 age-matched healthy children were selected randomly for the control group.Stastistical treatment:Use SPSS 13.0 package to analysis all the data.The data in the experiment will be expressed in the form of Mean±Standard deviation((x|ˉ)±s). Among IL-1β,TNF-α,IL-6,IL-10,IgM,IgG,IgA,C3,C4,WBC,Glu,CRP,the group differences were analysed by the One-Way analysis of variance (One-Way ANOVA),in which significant difference are indicated if P<0.05.Spearman Correlate analysis will be employed to analyze correlation between IL-1β,TNF-α,IL-6,IL-10 and WBC,Glu,CRP.Results:1. With the developing of HFMD,the serum levels of IL-1β,TNF-α,IL-6,IL-10 increased.The levels of serum cytokines from severe group were significantly higher than that from general group and control group and there were statistically significant differences (P<0.01). But there were no statistically significant differences between control group and general group (P>0.05).2. In children with HFMD, there were possitive correlations between L-1βand TNF-α(r=0.966,P<0.01),between L-1βand IL-6(r=0.872,P<0.01),between L-1βand IL-10(r=0.881,P<0.01),between TNF-αand IL-6 (r=0.859,P<0.01),between TNF-α and IL-10(r=0.884 , P<0.01),and between IL-6and IL-10 (r=0.867 , P<0.01) respectively.There were no significant correlations between levels of IL-1β,TNF-α,IL-6,IL-10 and CRP,Glu,WBC.3. The levels of IgM,IgG,IgA from severe group were significantly lower than that from control group.And there were statistically significant differences between two groups (P<0.01).Conclusion:1. For the levels of cytokines in HFMD,there were statistically significant differences between control group and severe group. The high concentrations of IL-1β,IL-6,IL-10,TNF-αin children with severe HFMD suggested that patients experience severe inflammatory and anti- inflammatory reaction when the virus attacks the body.Levels of IL-1β,IL-6,IL-10,TNF-αcould be used as the diagnosis index in HFMD.2. Certain correlations existed in the serum levels of IL-1β,IL-6,IL-10,TNF-αin children with HFMD,which suggested that the development of HFMD may be the results of the interaction and mutual adjustment of many cytokines.3. The low levels of IgM,IgG,IgA in children with severe HFMD suggested that enterovirus infection may lead to a certain degree of body changes in humoral immune function, and may have a certain degree with the disease relevance.