Association of serum 25-(OH) D levels with severe enterovirus 71 related children with hand, foot and mouth disease

Song He; Zhang Yufeng; Deng Huiling; Wang Jun; Xu Pengfei; Li Yaping; Yuan Juan; Liu Ruiqing; Tang Tiantian

doi:10.3877/cma.j.issn.1674-1358.2020.01.007

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血清25-羟基维生素D水平与肠道病毒71型手足口病患儿重症化的关联性

中华实验和临床感染病杂志（电子版）, 2020,14(01) : 40-45. DOI: 10.3877/cma.j.issn.1674-1358.2020.01.007

摘要

目的

探讨血清25-羟基维生素D[25-（OH）D]水平与肠道病毒71型（EV71）手足口病（HFMD）患儿重症化的关联性。预测25-（OH）D在EV71型HFMD重症化中的临床应用价值。

方法

选取西安市儿童医院2017年1月至2018年12月收治住院的EV71型HFMD患儿共255例为病例组，根据《手足口病诊疗指南（2018年版）》分为普通型150例（普通组）和重型105例（重型组）。同时随机选择同期儿童保健科体检的健康儿童50例为对照组。采用化学发光法检测血清25-（OH）D水平。收集病例组临床资料，采用回顾性研究方法，设计统一的调查分析表，记录其可能影响因素的资料，对可能影响普通型HFMD转为重症HFMD的相关因素进行单因素和多因素Logistic回归分析，探讨普通EV71型HFMD转为重症EV71型HFMD的危险因素及血清25-（OH）D水平与EV71型HFMD患儿重症化的关联性。

结果

病例组患儿与对照组25-（OH）D水平[（35.66 ± 11.60）ng/mlvs.（49.63 ± 8.86）ng/ml]差异有统计学意义（t= 8.06、P <0.001）。单因素分析显示EV71型HFMD重症组与普通组患儿相比，WBC>15 × 10⁹/L（χ²= 26.616、P <0.001）、血糖>8.3 mmol/L（χ²= 26.616、P <0.001）、血清25-（OH）D水平（t = 5.551、P <0.001）差异均有统计学意义。多因素Logistic回归分析显示，血糖>8.3 mmol/L（OR= 2.682、P = 0.028）、WBC>15 × 10⁹/L（OR= 2.090、P = 0.019）、25-（OH）D<30.88 ng/ml（OR= 3.792、P <0.001）均为重症发生的独立危险因素，差异均有统计学意义。

结论

25-（OH）D<30.88 ng/ml与EV71型HFMD严重程度密切相关，具有重要的预测价值，为EV71型HFMD感染重症化的预警因素。

引用本文: 宋鹤, 张玉凤, 邓慧玲, 等. 血清25-羟基维生素D水平与肠道病毒71型手足口病患儿重症化的关联性 [J/CD] . 中华实验和临床感染病杂志（电子版）,2020,14 (01): 40-45. DOI: 10.3877/cma.j.issn.1674-1358.2020.01.007

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手足口病（hand foot and mouth disease，HFMD）是由肠道病毒（enterovirus，EV）感染引起的一种儿童常见传染病，5岁以下儿童多发；在近年来丙类传染病中病死率最高，主要由肠道病毒柯萨奇病毒A16（Coxsackievirus A16，CoxA16）、肠道病毒71型（enterovirus 71，EV71）等感染引起，重症及死亡病例多由EV71所致^[1,2]。目前其致病机制和致死原因尚不明确，故早期识别导致EV71型HFMD重症化的危险因素，给予及时干预非常必要。

贡献者信息

宋鹤

710021　西安市，西安医学院；710003　西安市；西安市儿童医院感染二科

张玉凤

西安市儿童医院感染二科

邓慧玲

西安市儿童医院感染二科

王军

西安市儿童医院感染二科

徐鹏飞

西安市儿童医院感染二科

李亚萍

710004　西安市，西安交通大学第二附属医院感染科

袁娟

西安市儿童医院感染二科

刘瑞清

西安市儿童医院感染二科

唐甜甜

西安市儿童医院感染二科

通信作者

邓慧玲

西安市儿童医院感染二科

Email：denghuiling70@126.com

关键词

肠道病毒71型; 手足口病; 25-羟基维生素D; 危险因素;

基金项目

西安市科学技术局医疗卫生研究资助项目（No. 2016052 SF/YX08）

西安市科技计划项目（No. 201805098YX6SF32（7））

陕西省科技统筹重点产业创新链工程计划资助项目（No. 2016KTZD SF02-04）

作者声明

宋鹤，张玉凤，邓慧玲，等.血清25-羟基维生素D水平与肠道病毒71型手足口病患儿重症化的关联性[J/CD].中华实验和临床感染病杂志（电子版）, 2020,14(1):40-45.

历史

出版日期：2020-02-15

收稿日期：2019-05-29

本文编辑

孙荣华

Research Article

Association of serum 25-(OH) D levels with severe enterovirus 71 related children with hand, foot and mouth disease

Song He, Zhang Yufeng, Deng Huiling, Wang Jun, Xu Pengfei, Li Yaping, Yuan Juan, Liu Ruiqing, Tang Tiantian

Published 2020-02-15

Cite as Chin J Exp Clin Infect Dis (Electronic Edition), 2020,14(01): 40-45. DOI: 10.3877/cma.j.issn.1674-1358.2020.01.007

Abstract

Objective

To investigate the association of serum 25-(OH) D levels with severity of children with enterovirus 71 (EV71) related hand, foot and mouth disease (HFMD) and to predict the clinical value of 25-(OH) D in severe HFMD of type EV71.

Methods

A total of 255 children with EV71 HFMD admitted to Xi’an Children’s Hospital from January 2017 to December 2018 were selected as case group, including 150 mild cases (mild group) and 105 severe cases (severe group). Meanwhile, 50 healthy children who were randomly selected for physical examination in the same period were selected as control group. Serum 25-(OH) D levels were measured by chemiluminescence. The clinical data of case groups were collected by a retrospective research method, a unified survey and analysis tables were designed, the data of possible influencing factors were recorded. The univariate and multivariate Logistic regression analysis on factors that may affect the conversion of mild HFMDinto severe HFMD were done. The risk factors of mild EV71 type HFMD into severe EV71 type HFMD and the relationship between serum 25-(OH) D level and severe EV71 related HFMD were investigated, respectively.

Results

The levels of 25-(OH) D between cases with EV71 HFMD and control group [(35.66 ± 11.60) ng/mlvs. (49.63 ± 8.86) ng/ml] were significantly different (t= 8.062,P< 0.001). Univariate analysis showed thatcompared with the mild group, WBC > 15 × 10⁹/L (χ²= 26.616, P< 0.001), blood glucose > 8.3 mmol/L (χ²= 26.616, P< 0.001), serum 25-(OH) D levels (t= 5.551,P < 0.001) of cases in severe group were all withsignificant differences. Multivariate Logistic regression analysis showed that blood glucose > 8.3 mmol/L (OR=2.682, P= 0.028), WBC > 15 × 10⁹/L (OR= 2.090,P= 0.019) and 25-(OH) D < 30.88 ng/ml (OR= 3.792,P< 0.001) were all independent risk factors for severe illness, with significant differences.

Conclusions

25-(OH) D <30.88 ng/ml is significantly related to the severity of EV71 HFMD and has important predictive value, which is an early warning factor for severity of EV71 HFMD.

Key words:

Enterovirus 71; Hand, foot and mouth disease; 25-(OH) D; Risk factor

Contributor Information

Song He

Xi’an Medical College, Xi’an 710021, China;Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an 710003, China

Zhang Yufeng