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目的探讨去甲肾上腺素(NE)在重症手足口病(HFMD)病理生理过程中的作用机制,寻找重症HFMD患儿病情进展的早期预警指标。方法以304例重症HFMD患儿及19例因HFMD死亡患儿(共323例)为研究对象,所有病例分为3组:重症组、危重症组及死亡组,所有患儿入院后在其病程急性期测定血清NE水平,同时行血常规、血糖、心肌酶及病原学等常规检查。应用SPSS13.0软件对各组数据进行分析。结果 HFMD≤3岁患儿288例,占89.2%。318例(98.5%)患儿有发热症状,322例(99.7%)患儿有不同部位的皮疹,1例无皮疹者为死亡病例。3组血清NE水平均明显高于正常值,且随病情进展NE有增高趋势;随病情进展呼吸、心率逐渐增快,血压逐渐增高,3组比较差异均有统计学意义(Pa<0.01);血糖、白细胞、脑脊液蛋白、CK-MB随病情进展亦有增高趋势,死亡组明显高于其他2组(P<0.01,0.05);107例患儿实验室病原学检查阳性,其中EV71感染患儿75例(70.1%)。结论血清NE水平增高、EV71病原学阳性、脑脊液蛋白及血中CK-MB增高,均是重症HFMD病例的早期识别指标。
Objective To investigate the mechanism of norepinephrine (NE) in the pathophysiology of severe hand-foot-and-mouth disease (HFMD) and find the early warning index for the progression of severe HFMD. Methods Totally 304 children with severe HFMD and 19 children died of HFMD were enrolled in this study. All patients were divided into 3 groups: severe group, critically ill group and death group. All patients were admitted to hospital after their course of disease Acute phase determination of serum NE levels, while blood routine, blood glucose, myocardial enzymes and etiology and other routine examination. Application SPSS13.0 software for each group of data analysis. Results 288 cases of HFMD ≤ 3 years old, accounting for 89.2%. 318 (98.5%) children had fever symptoms, 322 (99.7%) children had different parts of the skin rash, 1 case of no rash were deaths. The levels of NE in serum were significantly higher than those in normal group (P <0.01), and NE increased with the progression of disease. With the progression of disease, the heart rate gradually increased and blood pressure gradually increased. The differences among the three groups were statistically significant (Pa. Blood glucose, leucocyte and cerebrospinal fluid protein, CK-MB also increased with the progress of the disease, the death group was significantly higher than the other two groups (P <0.01,0.05); 107 cases of children with positive laboratory tests, EV71 infection in children 75 cases (70.1%). Conclusions Elevated serum NE level, positive EV71 etiology, elevated cerebrospinal fluid protein and elevated CK-MB in blood are the early markers for the diagnosis of severe HFMD.