目的 探讨不同肠道病毒感染手足口病(HFMD)患儿儿茶酚胺(CA)、S-100蛋白和D-乳酸水平的变化及其临床意义.方法 选取2014年4-7月在昆明市儿童医院感染科住院并确诊为HFMD的患儿129例.使用GC-2016γ放射免疫计数仪采用放射免疫法进行CA测定〔主要包括去甲肾上腺素(NE)、肾上腺素(AD)、多巴胺(DA)〕;使用美国宝莱特ELx800NB酶标仪采用酶联免疫法进行S-100蛋白测定;使用美国宝莱特ELx800NB酶标仪采用酶联免疫法进行D-乳酸测定;使用德国ABI公司生产的7500PCR扩增仪采用实时荧光定量PCR方法进行粪便病原体的检测及分型.结果 129例HFMD患儿中,肠道病毒71型(EV71)阳性57例(44.2%),柯萨奇病毒A组16型(CoxA16)阳性26例(20.2%),其他肠道病毒阳性20例(15.5%),肠道病毒阴性26例(20.1%).不同肠道病毒感染HFMD患儿NE、AD、DA、S-100蛋白水平比较,差异无统计学意义(P>0.05);不同肠道病毒感染HFMD患儿D-乳酸水平比较,差异有统计学意义(P<0.05),其中EV71阳性HFMD患儿D-乳酸水平高于其他肠道病毒阳性、肠道病毒阴性患儿.结论 不同肠道病毒感染HFMD患儿CA、S-100蛋白水平间无差异,而EV71感染HFMD患儿D-乳酸水平较高,存在肠屏障通透性增加.%Objective To investigate the changing level of catecholamine(CA),S-100 protein and D-lactic acid of children with hand-foot-and-mouth disease(HFMD) infected by different enterovirus and its clinical significance.Methods A total of 129 children with HFMD hospitalized in Kunming Children′s Hospital from April to July 2014 were enrolled.With GC-2016γ radioimmunoassay counter,CA 〔including noradrenaline(NE),adrenaline(AD) and dopamine(DA)〕 was measured by radioimmunoassay;with the American Boxlight ELx800NB microplate reader,the S-100 protein was measured by enzyme-linked immunosorbent assay;and D-lactic acid was measured by enzyme-linked immunosorbent assay.With 7500PCR amplifier produced by ABI company in Germany,the real-time quantitative PCR method was used to detect and classify fecal pathogens.Results Of the 129 children with HFMD,57(44.2%) were enterovirus 71(EV71)-positive,26(20.2%) were 16-type coxsackievirus A(CoxA16)-positive,the detection of 20(15.5%) was positive in other enteroviruses,and the detection of 26(20.1%) was negative in enteroviruses.There were no significant differences in NE,AD,DA and S-100 protein levels among children with HFMD infected by different enterovirus(P>0.05).The levels of D-lactic acid in the subjects were significantly different(P<0.05).The level of D-lactic acid in HFMD children of EV71-positive was higher than that in children of other enteroviruses-positive and enteroviruses-negative.Conclusion There are no differences in levels of CA and S-100 protein among children with HFMD infected by different enterovirus.The level of D-lactic acid in children with HFMD by EV71 is higher and the permeability of intestinal barrier is increased.
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