| Objection: EV71 is a member of positive and small single-strand RNA virus family,the prevalence of EV71 infection in the Asia Pacific region showed an upward trend in recent years,especially in China mainland.The clinical manifestations of EV71 infection are related not only to the virulence of the virus,but also to the susceptibility of host.It was found that the polymorphism of carnitine palmitoyl transferase?(CPT?)gene is associated with susceptibility to EV71 infection in many researches.The purpose of this study is to investigate whether the CPT?gene 1939A/G polymorphism is related to susceptibility to EV71 infection or not,and compared blood ATP level between G allele carriers and AA genotype in EV71 encephalitis patients.Methods: This study collected 438 cases from the pediatric ward of the Affiliated Hospital of Qingdao University and Qingdao Women & Children Hospital during HFMD epidemic period from May 2009 to October 2014,and recorded their data of clinical and laboratory examination in detail.Among them,406 cases were diagnosed as EV71 infection and 32 cases were diagnosed as non EV71 infection.And 406 patients with EV71 infection were selected as the case group,including 215 male and 191 female,the average age was 4.05±1.57(years);at the same time 348 normal children who underwent physical examination in the Affiliated Hospital of Qingdao University consisted of control group,including 182 male and 166 female,the average age was 3.92±1.31(years).According to the difference of laboratory examination and clinical manifestations,EV71 infection group were divided into mild group(n=198)and severe group(n=208);Depending on whether or not to cause encephalitis,severe EV71 infection group was divided into EV71 encephalitis group(n=186)and non EV71 encephalitis group(n=22);on the basis of the severity of clinical manifestations of central nervous system,the EV71 encephalitis group were segmented into mild group(n=146)and severe group(n=40).Genomic DNA were extracted from peripheral blood leukocytes in EV71 infected patients and normal children,and then the polymorphism of CPT? gene 1939A/G were detected by polymerase chain reaction(PCR),and blood ATP level were determined indirectly by fluorescence spectrophotometer in patients with encephalitis.All statistical data was processed by SPSS16.0 software,the quantitative data of normal distribution werecompared by t test.,the data of non normal distribution were analyzed by Wilcoxon rank sum test,the qualitative data were compared by chi square test,and significance was set at a p-value of<0.05.Results:There was no significant difference in age and gender between the case group and the control group(4.05±1.57 vs.3.92±1.31,p=0.203 vs.c 2=0.31,p=0.860).The frequency of AG+GG genotype and G allele in EV71 infection group was significantly lower than the normal control group(17.2% vs.24.7,p=0.012,OR=0.635,95%CI=0.445-0.905 vs.9.2% vs.12.9%,p=0.022,OR=0.685,95%CI=0.495-0.948);and in severe EV71 infection group,the frequency of AG+GG genotype and G allele was evidently lower than the matched group(15.4% vs.24.7%,p=0.009,OR=0.554,95%CI=0.354-0.867 vs.8.4% vs.12.9%,p=0.021,OR=0.619,95%CI=0.410-0.933),and the proportion of AG+GG genotype and G allele had no statistical difference between mild EV71 infection group and control group(p=0.139 vs.p=0.165).The ratio of AG+GG genotype and G allele in EV71 encephalitis group was remarkably lower than the control group(15.1% vs.24.7%,p=0.009,OR=0.540,95%CI=0.337-0.864 vs.8.3% vs.12.9%,p=0.024,OR=0.612,95%CI=0.399-0.940).And there was no significant difference in AG+GG genotype and G allele between the mild EV71 encephalitis group and matched group(p=0.094 vs.p=0.186);however,compared with control group,the frequency of AG+GG genotype and G allele in severe EV71 encephalitis group was observably lower(5% vs.24.7%,p=0.005,OR=0.160,95%CI=0.038-0.679 vs.2.5% vs.12.9%,p=0.006,OR=0.173,95%CI=0.042-0.715).What's more,the AG+GG genotype and G allele of severe encephalitis group was markedly less than mild EV71 encephalitis group(5.0% vs.17.8%,p=0.045,OR=0.243,95%CI=0.055-1.071 vs.2.5% vs.10.0%,p=0.033,OR=0.233,95%CI=0.054-0.996).In EV71 infection group,compared with the AG+GG genotype,AA genotype group had higher white blood cell count and CRP(11.31±2.83 vs.10.65±2.38,p=0.044 vs.8.35±4.20 vs.6.37±4.30,p=0.000),and EV71 encephalitis group had the same results(12.59±2.55 vs.10.04±2.14,p=0.000 vs.12.55±2.57 vs.6.70±2.14,p=0.000).The blood ATP level in AG+GG genotype group was significantly higher than that in AA genotype group(0.97±0.12 vs.0.87±0.08,t=3.879,p=0.001).Conclusion: The polymorphism of CPT?gene rs1799822 is associated with EV71infection;the polymorphism of CPT?gene rs1799822 is relevant to EV71 encephalitis,and may be a protective factor of EV71 encephalitis,especially in severe EV71encephalitis;the blood ATP level of AG+GG genotype is significantly lower than AA genotype in patients with EV71 encephalitis. |
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