重症手足口病患儿血清S100B和NSE水平与T淋巴细胞亚群的相关性研究

韦祎+梁薇+黄月艳+唐汉庆+李晓华+李清锋+谢毅强+谢跃琦+温晓梅

【摘要】目的观察重症手足口病（HFMD）患儿血清星形胶质源性蛋白（S100B）和神经元特异性烯醇化酶（NSE）水平与T淋巴细胞亚群的变化及相关性，并讨论其临床价值。方法选取2015年1～9月收治的HFMD患儿156例，包括普通病例80例（普通组），重症病例76例（重症组），另外选取70例健康幼儿作为对照组。采用流式细胞技术检测外周血T淋巴细胞亚群，采用ELISA法检测血清S100B和NSE水平，并分析血清S100B和NSE水平与T淋巴细胞亚群的相关性。结果与对照组比较，普通组和重症组T淋巴细胞总数、CD4+、CD8+、CD4+ /CD8+均降低，且重症组降低更加明显（P<0.01）。与对照组和普通组比较，重症组血清S100B水平（1.64±0.28）μg/L和NSE水平（5283±4.68）ng/ml均升高（P<0.01）。重症组血清S100B和NSE水平与T淋巴细胞亚群呈负相关（P<0.01）。结论T淋巴细胞亚群和血清S100B、NSE水平指标组合对于重症手足口病的早期识别具有一定的参考价值。

【关键词】手足口病；T淋巴细胞亚群；星形胶质源性蛋白；神经元特异性烯醇化酶

中图分类号：R512.5文献标识码：ADOI：10.3969/j.issn.10031383.2016.05.005

【Abstract】ObjectiveTo investigate the correlation of the serum levels of S100B，NSE and Tlymphocyte subsets in children with severe handfootmouth disease （HFMD） and discuss their clinical value.MethodsA total of 156 children with HFMD admitted to hospital from January to September，2015 were collected and divided into general group （80 cases） and severe group （76 cases），70 healthy children were selected as control group.Changes of peripheral blood Tlymphocyte subsets were examined by flow cytometry and the serum levels of S100B and NSE were detected by ELISA.In addition，the correlation of the serum levels of S100B，NSE and Tlymphocyte subsets was discussed.ResultsCompared with the control group，total amount of T lymphocyte，CD4+，CD8+ and CD4+/CD8+ of both the general group and the severe group all decreased，and those of the severe group decreased more significantly（P<0.01）.Compared with the control group and the general group，both the serum level of S100B（1.64±0.28）μg/L and the serum level of NSE（52.83±4.68）ng/ml in the severe group all increased（P<0.01）.The levels of serum S100B and NSE were negatively correlated with T lymphocyte subsets in the severe group（P<0.01）.ConclusionCombination of Tlymphocyte subsets and the serum levels of S100B and NSE can provide definite reference value in the early identification of severe HFMD.

【Key words】HFMD；Tlymphocyte subsets；S100B； NSE

手足口病（handfootmouth disease，HFMD）是兒科常见传染病，临床表现轻重不同，具有传播较快、传染性较强的特点。轻型以手、足、口腔、臀部出现斑丘疹、疱疹体征为主，而重症型多累及神经系统，出现脑炎、无菌性脑脊髓膜炎等脑损伤病变。重症型患儿病情进展快，由于对重症型辨别主要靠临床症状，当出现脑损伤表现时，病情往往已很严重，临床治疗难度增大，病死率高。因此，早期辨识重症型值得探讨。HFMD由肠道病毒感染所致，常见的病毒如肠道病毒71型（EV71）及柯萨奇病毒A16型（CoxA16）。研究表明病毒感染后，T淋巴细胞激活引起的免疫应答在HFMD发病机制中起着重要作用[1，2]，而血清星形胶质源性蛋白（S100B）和神经元特异性烯醇化酶（NSE）水平是反映脑损伤程度的灵敏指标[3]。本研究通过检测重症HFMD患儿外周血T淋巴细胞亚群和血清S100B、NSE水平变化并探讨其相关性，为重症HFMD的早期识别提供组合参考指标。……