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目的探讨肠道病毒71型(EV71)脑炎患儿血清和脑脊液中s CD40、s CD40L和血管细胞黏附分子-1(VCAM-1)水平的变化及其临床意义。方法根据临床表现将患儿分为普通病例组、重症病例组(再分为重型组和危重型组;所有重症病例组患儿在入院时定为急性期;在住院10~14 d后,根据患儿体温正常稳定,意识无障碍,无肢体抖动和惊厥,无呕吐等情况,定为恢复期),同时设立对照组。应用双抗体夹心ELISA法检测各组患儿血清和脑脊液中s CD40、s CD40L和VCAM-1的水平。结果重症病例组血清和脑脊液中s CD40、s CD40L和VCAM-1含量均显著高于普通病例组和对照组,差异有统计学意义;普通病例组血清和脑脊液中s CD40、s CD40L和VCAM-1含量与对照组差异无统计学意义。危重型组血清和脑脊液中s CD40、s CD40L和VCAM-1含量均显著高于重型组,差异有统计学意义。重症病例组恢复期血清和脑脊液中s CD40、s CD40L和VCAM-1含量均显著下降。重症病例组血清与脑脊液中s CD40、s CD40L和VCAM-1均呈正相关;且血清与脑脊液三指标间也均呈正相关。结论 s CD40、s CD40L和VCAM-1可能参与EV71脑炎的发病机制,对EV71脑炎的病情严重性评估及预后判断有一定意义。
Objective To investigate the changes of s-CD40, s-CD40L and vascular cell adhesion molecule-1 (VCAM-1) levels in serum and cerebrospinal fluid of children with enterovirus 71 (EV71) encephalitis and their clinical significance. Methods According to the clinical manifestations, the children were divided into common case group and severe case group (subdivided into severe group and severe group; all severe cases were admitted as acute stage; after 10 to 14 days of hospitalization, Children with normal and stable body temperature, awareness of accessibility, no limb jitter and convulsions, no vomiting, etc., as the recovery period), while the establishment of the control group. The levels of s-CD40, s CD40L and VCAM-1 in serum and cerebrospinal fluid in each group were detected by double antibody sandwich ELISA. Results Serum and cerebrospinal fluid concentrations of sCD40, sCD40L and VCAM-1 in severe cases were significantly higher than those in normal cases and controls (P <0.05). There were significant differences in sCD40, CD40L and VCAM- 1 content and the control group no significant difference. Serum and cerebrospinal fluid of patients with severe type of s CD40, s CD40L and VCAM-1 levels were significantly higher than the heavy group, the difference was statistically significant. Serum and cerebrospinal fluid concentrations of sCD40, sCD40L and VCAM-1 in convalescent cases were significantly decreased. Serum and CSF levels of CD40, CD40L and VCAM-1 in severe cases were positively correlated, and there was a positive correlation between serum and cerebrospinal fluid among the three indexes. Conclusion CD40, s CD40L and VCAM-1 may be involved in the pathogenesis of EV71 encephalitis, and have certain significance for evaluating the severity of EV71 encephalitis and prognosis.