基于倾向性评分匹配评估血清淀粉样蛋白A和白细胞介素6在手足口病中表达的临床意义

项琼莲; 朱丽娟; 张诗海

doi:10.16766/j.cnki.issn.1674-4152.002415

基于倾向性评分匹配评估血清淀粉样蛋白A和白细胞介素6在手足口病中表达的临床意义

doi: 10.16766/j.cnki.issn.1674-4152.002415

安徽省儿童医院检验科，安徽合肥 230051

基金项目:

吴阶平医学基金会临床科研专项资助基金课题 320.6750.17377

详细信息

通讯作者:
项琼莲，E-mail: xql1983@126.com

中图分类号: R511 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-05
- 网络出版日期: 2022-08-20

Clinical significance of serum amyloid protein A and interleukin-6 expression in hand, foot and mouth disease on the basis of propensity score matching

Department of Clinical Laboratory, Anhui Provincial Children's Hospital, Hefei, Anhui 230051, China

摘要

摘要: 目的探讨血清淀粉样蛋白A(SAA)、白细胞介素6(IL-6)在不同类型手足口病(HFMD)中的表达情况。方法随机选择安徽省儿童医院2017年1月—2020年11月间收治的HFMD患儿216例作为观察对象，其中普通型HFMD患儿145例，重症HFMD患儿71例。采用倾向性评分匹配(PSM)方法进行1∶ 1匹配，匹配变量包括年龄、性别、病程、入院后采血时间、是否伴有咳嗽流涕、食欲不振等临床表现。用逆转录聚合酶链反应检测患者粪便中肠道病毒71(EV-A71)RNA，观察EV-A71在HFMD患儿中的分布。观察不同类型HFMD患儿静脉血SAA、IL-6表达的差异。结果重症型HFMD、普通型HFMD患者SAA、IL-6表达分别为[(162.50±11.23)mg/L vs.(10.28±2.06)mg/L；(49.96±6.85)pg/mL vs.(23.11±4.98)pg/mL]，重症HFMD组患儿血清SAA、IL-6表达水平均高于普通型HFMD(均P＜0.01)。重症型HFMD组中EV-A71阳性比例明显高于普通型组(χ²=9.100，P=0.003)。重症型、普通型HFMD组中EV-A71阳性患儿的IL-6、SAA表达水平均显著高于EV-A71阴性患儿(均P＜0.01)。EV-A71阳性、EV-A71阴性HFMD患儿SAA、IL-6表达分别为[(93.65±6.71)mg/L vs.(80.40±5.83)mg/L、(45.57±5.88)pg/mL vs.(28.37±3.15)pg/mL], EV-A71阳性HFMD组患儿血清SAA、IL-6表达水平均高于EV-A71阴性HFMD组(均P＜0.001)。结论 SAA、IL-6参与了HFMD的发病过程，并且和HFMD分型、EV-A71表达密切相关。
- 倾向性评分匹配 /
- 手足口病 /
- 血清淀粉样蛋白A /
- 白细胞介素6 /
- 肠道病毒71
Abstract: Objective To investigate the expression of serum amyloid A (SAA) and interleukin-6 (IL-6) in different types of hand, foot and mouth disease (HFMD). Methods A total of 216 children with HFMD admitted to Anhui Provincial Children's Hospital from Jan. 2017 to Nov. 2020 were randomly selected as the observation objects, including 145 children with common HFMD and 71 children with severe HFMD. Propensity score matching method was used for 1∶ 1 matching. The matching variables included age, gender, course of disease, blood collection time after admission, cough, runny nose, loss of appetite and other clinical manifestations. The distribution of enterovirus 71 (EV-A71) RNA in the faeces of HFMD patients was observed by reverse transcription polymerase chain reaction. The expression of SAA and IL-6 in venous blood of children with different types of HFMD were observed. Results The expression levels of SAA and IL-6 in patients with severe HFMD and common HFMD were (162.50±11.23) mg/L vs. (10.28±2.06) mg/L and (49.96±6.85) pg/mL vs. (23.11±4.98) pg/mL, respectively. The expression levels of SAA and IL-6 in the severe HFMD group were higher than those in the common HFMD group (all P < 0.01). The positive rate of EV-A71 in the severe HFMD group was significantly higher than that in the normal HFMD group (χ²=9.100, P=0.003). The expression levels of IL-6 and SAA in patients with EV-A71-positive HFMD were significantly higher than those in patients with EV-A71-negative HFMD in both groups (all P < 0.01). The expression levels of SAA and IL-6 in the EV-A71-positive HFMD group and EV-A71-negative HFMD group were (93.65±6.71) mg/L vs. (80.40±5.83) mg/L and (45.57±5.88) pg/mL vs. (28.37±3.15) pg/mL, respectively. The expression levels of serum SAA and IL-6 in the EV-A71-positive HFMD group were higher than those in the EV-A71-negative HFMD group (all P < 0.01). Conclusion SAA and IL-6 are involved in the pathogenesis of HFMD and closely related to HFMD typing and EV-A71 expression.
- Propensity score matching /
- Hand, foot and mouth disease /
- Serum amyloid A /
- Interleukin-6 /
- Enterovirus 71

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表 1 2组HFMD患者匹配前后各影响因素基线比较

Table 1. Baseline comparison of each influencing factor before and after matching between two groups of HFMD patients

项目	PSM前				PSM后
项目	普通型(n=145)	重症(n=71)	统计量	P值	普通型(n=61)	重症(n=61)	统计量	P值
年龄(x±s，月)	40.80±11.70	28.70±6.20	8.164^a	＜0.001	31.03±7.35	29.59±6.68	1.132^a	0.260
男性[例(%)]	81(55.86)	32(45.07)	2.225^b	0.136	31(50.82)	28(45.90)	0.295^b	0.587
病程(x±s，d)	6.60±1.28	3.20±0.95	19.855^a	＜0.001	4.01±1.15	3.87±1.02	0.711^a	0.478
入院后采血时间(x±s，h)	15.80±5.33	11.50±3.55	6.158^a	＜0.001	12.06±4.16	11.03±3.27	1.520^a	0.131
临床表现[例(%)]			18.463^b	＜0.001			2.275^b	0.131
咳嗽、流涕	35(24.14)	27(38.03)			28(45.90)	27(44.26)
食欲不振	18(12.41)	21(29.58)			17(27.87)	16(26.23)
注：^a为t值，^b为χ²值。

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表 2 不同类型HFMD患儿血清IL-6、SAA表达比较(x±s)

Table 2. Comparison of serum IL-6 and SAA expressions in children with different types of HFMD (x±s)

组别	例数	IL-6(pg/mL)	SAA(mg/L)
重症型	61	49.96±6.85	162.50±11.23
普通型	61	23.11±4.98	10.28±2.06
t值		24.762	104.129
P值		＜0.001	＜0.001

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表 3 不同EV-A71表达情况HFMD患儿血清IL-6、SAA表达比较(x±s)

Table 3. Comparison of serum IL-6 and SAA expressions in HFMD children with different EV-A71 expression (x±s)

组别	例数	IL-6(pg/mL)	SAA(mg/L)
EV-A71阳性	78	45.57±5.88	93.65±6.71
EV-A71阴性	44	28.37±3.15	80.40±5.83
t值		18.873	11.642
P值		＜0.001	＜0.001

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表 4 2组重症型患者中EV-A71阳性与阴性HFMD患儿SAA、IL-6表达比较(x±s)

Table 4. Comparison of SAA and IL-6 expressions in EV-A71 positive and negative HFMD children in two groups of severe patients (x±s)

组别	例数	IL-6(pg/mL)	SAA(mg/L)
EV-A71阳性	47	50.65±7.90	165.53±18.55
EV-A71阴性	14	25.16±4.83	83.75±9.60
t值		11.414	21.931
P值		＜0.001	＜0.001

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表 5 2组普通型患者中EV-A71阳性与阴性HFMD患儿SAA、IL-6表达比较(x±s)

Table 5. Comparison of SAA and IL-6 expression in children with EV-A71 positive and negative HFMD in two groups of common type patients (x±s)

组别	例数	IL-6(pg/mL)	SAA(mg/L)
EV-A71阳性	31	30.40±5.12	15.65±3.76
EV-A71阴性	30	19.60±3.85	8.03±1.96
t值		9.288	9.876
P值		＜0.001	＜0.001

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参考文献(18)

[1]	中华人民共和国国家卫生健康委员会. 手足口病诊疗指南(2018年版)[J]. 中华临床感染病杂志, 2018, 11(3): 161-166. doi: 10.3760/cma.j.issn.1674-2397.2018.03.001 National Health Commission of the People's Republic of China. Diagnosis and treatment guideline on hand-foot-mouth disease(2018)[J]. Infectious Disease Information, 2018, 11(3): 161-166. doi: 10.3760/cma.j.issn.1674-2397.2018.03.001
[2]	ZHAO J, JIANG F, ZHONG L, et al. Age patterns and transmission characteristics of hand, foot and mouth disease in China[J]. BMC Infect Dis, 2016, 16(1): 691. doi: 10.1186/s12879-016-2008-y
[3]	陈璐, 任静朝, 段广才, 等. 手足口病重症化影响因素分析及预测模型的建立[J]. 中华实用儿科临床杂志, 2017, 32(6): 469-471. doi: 10.3760/cma.j.issn.2095-428X.2017.06.017 CHEN L, REN J C, DUAN G C, et al. Influence factors analysis and prediction model construction of severe hand- foot- mouth disease[J]. Journal of Applied Clinical Pediatrics, 2017, 32(6): 469-471. doi: 10.3760/cma.j.issn.2095-428X.2017.06.017
[4]	PEI X, FAN X, ZHANG H, et al. Low frequency, weak MCP-1 secretion and exhausted immune status of peripheral monocytes were associated with progression of severe enterovirus A71-infected hand, foot and mouth disease[J]. Clin Exp Immunol, 2019, 196(3): 353-363. doi: 10.1111/cei.13267
[5]	ZHAO X, LI C, LIU X, et al. Human intestinal organoids recapitulate enteric infections of enterovirus and coronavirus[J]. Stem Cell Reports, 2021, 16(3): 493-504. doi: 10.1016/j.stemcr.2021.02.009
[6]	XU Y C, LI S X, CAI C Y, et al. Characterization of inflammatory cytokine profiles in cerebrospinal fluid of hand, foot, and mouth disease children with enterovirus 71-related encephalitis in Hangzhou, Zhejiang, China[J]. Medicine (Baltimore), 2019, 98(52): e18464. DOI: 10.1097/MD.0000000000018464.
[7]	陈文航, 李慧慧, 周权, 等. 基于倾向评分匹配法的高血压对妊娠相关性急性肾损伤预后影响的回顾性队列研究[J]. 中南大学学报(医学版), 2020, 45(7): 797-803. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202007009.htm CHEN W H, LI H H, ZHOU Q, et al. Effect of hypertension on prognosis in patients with pregnancy-related acute kidney injury: A retrospective, propensity score-matched cohort study[J]. Journal of central south university (med edition), 2020, 45(7): 797-803. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202007009.htm
[8]	FENG Y, HE X G, ZHOU C M, et al. Comparison of hepatic resection and systemic treatment of breast cancer liver metastases: A propensity score matching study[J]. Am J Surg, 2020, 220(4): 945-951. doi: 10.1016/j.amjsurg.2020.02.047
[9]	ESNAULT S, KHOSRAVI M, KELLY E A, et al. Increased IL-6 and Potential IL-6 trans-signalling in the airways after an allergen challenge[J]. Clin Exp Allergy, 2021, 51(4): 564-573. doi: 10.1111/cea.13832
[10]	庞文箫, 易冬玲, 张朝勇, 等. 重症手足口病患儿外周血炎性因子、神经元特异性烯醇化酶与中枢神经特异性S100β蛋白水平变化[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(3): 250-254. doi: 10.3877/cma.j.issn.1674-1358.2019.03.014 PANG W X, YI D L, ZHANG C Y, et al. Changes of inflammatory factors, neuron-specific enolase and central nervous system specific protein S100β in peripheral blood of children with severe hand, foot and mouth disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Version), 2019, 13(3): 250-254. doi: 10.3877/cma.j.issn.1674-1358.2019.03.014
[11]	罗云娇, 杜曾庆, 杜丽江, 等. 肠道病毒71型手足口病患儿血清TGFβ及白细胞介素水平变化分析[J]. 中华医院感染学杂志, 2016, 26(15): 3546-3547, 3550. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201615069.htm LUO Y J, DU Z Q, DU L L, et al. Changes of serum TGF-βand interleukins in patients with hand-foot-mouth disease induced by EV71[J]. Chinese Journal of Nosocomiology, 2016, 26(15): 3546-3547, 3550. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201615069.htm
[12]	LEE J Y, SON M, KANG J H, et al. Serum interleukin-6 levels as an indicator of aseptic meningitis among children with enterovirus 71-induced hand, foot and mouth disease[J]. Postgrad Med, 2018, 130(2): 258-263. doi: 10.1080/00325481.2018.1416257
[13]	李梅爱, 刘云锋, 邝婉仪, 等. 血清淀粉样蛋白A检测在手足口病中的诊断意义[J]. 中国卫生检验杂志, 2019, 29(5): 565-567. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201905018.htm LI M A, LIU Y F, KUANG W Y, et al. Significance of serum amyloid A protein detection in diagnosing hand-foot-mouth disease[J]. Chinese Journal of Health Laboratory Technology, 2019, 29(5): 565-567. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201905018.htm
[14]	张诗海, 孙丽. 血清淀粉样蛋白A和急性时相蛋白C反应蛋白在不同病毒所致手足口病患儿中的诊断效能[J]. 医学综述, 2020, 26(16): 3313-3316, 3322. doi: 10.3969/j.issn.1006-2084.2020.16.036 ZHANG S H, SUN L. Diagnostic Efficacy of Serum Amyloid A and Acute Phase Protein C Reactive Protein in Children with Hand, Foot and Mouth Disease Caused by Different Viruses[J]. Medical Recapitulate, 2020, 26(16): 3313-3316, 3322. doi: 10.3969/j.issn.1006-2084.2020.16.036
[15]	WU F, HOU X Q, SUN R R, et al. The predictive value of joint detection of serum amyloid protein A, PCT, and Hs-CRP in the diagnosis and efficacy of neonatal septicemia[J]. Eur Rev Med Pharmacol Sci, 2019, 23(13): 5904-5911.
[16]	彭致平, 黄明兰, 隋洪. 联合检测SAA和CRP对小儿感染性疾病的早期鉴别诊断[J]. 实验与检验医学, 2017, 35(3): 416-418. doi: 10.3969/j.issn.1674-1129.2017.03.041 PENG Z P, HUANG M L, SUI H. Combined detection of SAA and CRP in early differential diagnosis of infectious diseases in children[J]. Experimental and Laboratory Medicine, 2017, 35(3): 416-418. doi: 10.3969/j.issn.1674-1129.2017.03.041
[17]	潘喜梅, 潘俊泉, 吴新良, 等. 联合SAA、CRP和PCT检测对小儿急性期感染诊断的应用价值分析[J]. 实验与检验医学, 2016, 34(6): 751-753. doi: 10.3969/j.issn.1674-1129.2016.06.017 PAN X M, PAN J Q, WU X L, et al. Application of SAA, CRP and PCT in the diagnosis of acute infection in children[J]. Experimental and Laboratory Medicine, 2016, 34(6): 751-753. doi: 10.3969/j.issn.1674-1129.2016.06.017
[18]	杨世明, 丁莉, 沈瑛, 等. 200例手足口病患儿临床表现及其实验室诊断[J]. 中华医院感染学杂志, 2021, 31(2): 291-295. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202102030.htm YANG S S, DING L, SHEN Y, et al. Clinical manifestations of 200 children with hand-foot-mouth disease and its laboratory diagnosis[J]. Chinese Journal of Nosocomiology, 2021, 31(2): 291-295. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202102030.htm