Clinical Characteristic And Cytokines Of Hand-Foot-Mouth Disease

Objective To study the clinical characteristic of different clinical types(common type, severe type and critical type) and changes characteristic ofcytokines by analyzing the clinical data and testing cytokines（TNF-α, IL-1β,IL-6, IL-8, IL-4, IL-10, IL-13）concentration level changes in peripheral bloodof hand, foot and mouth disease.Method62cases with hand, foot and mouth disease admitting in theaffiliated hospital of Guangxi medical university, Nanning maternity and childand Nanning fourth people’s hospital from March2009to December2011. Therewere37males and25females with mean age (1.56±0.89) years old.62patientswith hand, foot and mouth disease were examined, including20patients withcommon complication and42patients with serious illness case.20cases weresevere patients and22cases were critical patients.22healthy children werecontrols.2ml arterial blood were drew to measure cytokines (TNF-α, IL-1β, IL-6,IL-8, IL-4, IL-10, IL-13）in24hours after their being in hospital by ELISAmethods.Result Most of the patients were less than3years old and the dominant sexwas male. Among the severe and critical hand, foot and mouth disease, EV71were88.6%. Fever was found in most of the hand, foot and mouth disease. The thermal spike was proportional to disease severity. Critical patients sometimeswere atypical location. There were no statistical differences in leukocyte count,neutrophils percentage of all clinical classifications. Blood glucose was morecommon found in severe and critical patients, and its change was positivelyrelated with disease severity. CD4~+T lymphocytes in peripheral blooddecreased in critical patients. Single factor analysis showed that there werestatistical differences in hot peak, heart rate increase, platelet count, C-reactiveprotein, blood glucose, elevated anti-inflammatory cytokines and vomiting. Themultivariate unconditional Logistic regression showed that blood glucose, andvomiting were the risks of the critical cases. The levels of cytokines hadchanged in all clinical classifications. The levels of pro-inflammatory cytokinesincreased to a certain degree and more significance in severe and critical patients.But anti-inflammatory cytokines were differences in different clinical types.Compared with those in the control group, the concentrations ofanti-inflammatory in common type were dramatically, but there were nosignificance in severe and critical patients.Conclusion1. Our study showed most of hand, foot and mouth patientswere less than3years old, and the dominant sex was male. The main etiologywas EV71.2. The thermal spike was proportional to disease severity. Criticalpatients sometimes were atypical location. Cellular immune function was certaininhibited in critical patients.3. The regression analysis showed that seriousillness cases were related with the elevation of thermal spike, pulse, CRP, bloodglucose. And hyperglycemia was the main risk factors of disease progression infoot and mouth disease.4. The study showed that the levels of cytokinesincrease to a certain degree and is in associated with the severity of hand, foot and mouth disease. The more progression of the disease, the higher the serumlevels of pro-inflammatory cytokines（TNF-α, IL-1β, IL-6, IL-8）were, whileanti-inflammatory cytokine were lower.