目的 分析不同严重程度手足口病(HFMD)患儿血清生长激素释放肽(ghrelin)与胃肠功能障碍的关系,为临床诊疗提供依据。方法 选取2016年9月-2018年10月在无锡市儿童医院接受治疗的HFMD患儿130例为研究组,同期来院体检的健康儿童60例作为健康组,于清晨空腹采集静脉血,检测血清ghrelin、D-乳酸、内毒素、前降钙素(PCT)水平,进行胃肠功能评分(GIF评分),Pearson相关系数法分析ghrelin、D-乳酸、内毒素与PCT的相关性,受试者工作曲线(ROC)分析ghrelin、D-乳酸、内毒素、PCT对HFMD的临床诊断价值,对可能影响HFMD发生的因素进行Logistic回归分析。结果 研究组血清ghrelin显著低于健康组(t=17.764,P<0.05),GIF评分、血清D-乳酸、内毒素、PCT水平较健康组均显著升高(t=26.112、14.324、15.491、23.433,P＜0.05);危重症组、重症组患儿血清ghrelin水平显著低于普通组,危重症组患儿血清ghrelin水平显著低于重症组(F=105.761,P＜0.05);危重症组、重症组患儿GIF评分、血清D-乳酸、内毒素、PCT水平显著高于普通组,危重症组患儿上述指标显著高于重症组(P＜0.05)。Pearson相关性分析显示研究组患儿血清ghrelin与GIF评分、D-乳酸、内毒素、PCT均呈显著负相关(r=-0.549、-0.563、-0.667、-0.581,P<0.05);ghrelin、D-乳酸、内毒素和PCT的曲线下面积(AUC)分别为0.868、0.867、0.750和0.846;Logistic回归分析显示ghrelin、D-乳酸、内毒素与PCT均是影响HFMD的危险因素。结论 患儿血清ghrelin与HFMD严重程度及胃肠功能指标密切相关,随疾病严重程度增加而降低。

Objective To investigate the relationship between serum ghrelin and gastrointestinal dysfunction in children with different severity of hand-foot-mouth disease (HFMD),in order to provide reference for clinical treatment of HFMD. Methods A total of 130 children with HFMD admitted to Wuxi Children′s Hospital from September 2016 to October 2018 were selected as the study group,and 60 healthy children who took physical examination at the same period were selected as healthy group.The venous blood of the participants was collected in the morning,the levels of serum ghrelin,D-lactate,endotoxin and procalcitonin (PCT) were tested,and the gastrointestinal failure (GIF) score was evaluated.Pearson correlation analysis was used to analyze the correlations of ghrelin,D-lactate and endotoxin with PCT.And the values of ghrelin,D-lactate,endotoxin and PCT in the diagnosis of HFMD were analyzed by receiver operating curve (ROC).Logistic regression analysis was conducted to determine the factors that might affect the occurrence of HFMD. Results Serum level of ghrelin of the study group was significantly lower than that of the healthy group (t=17.764,P＜0.05),while the GIF score and the serum D-lactate,endotoxin and PCT levels were significantly higher than those of healthy group (t=26.112,14.324,15.491,23.433,P<0.05).Serum ghrelin level in critical HFMD children and severe HFMD children was significantly lower than that of typical HFMD children,and serum level of ghrelin was significantly lower in critical HFMD children than severe HFMD children (F=105.761, P<0.05).Moreover,GIF score,the levels of serum D-lactate,endotoxin and PCT in critical HFMD children and severe HFMD children were significantly higher than typical HFMD children,and those indexes were higher in critical HFMD children than severe HFMD children (P<0.05).Pearson correlation analysis showed that serum ghrelin level was negatively correlated with GIF score,serum D-lactic acid,endotoxin and PCT in HFMD children (r=-0.549,-0.563,-0.667,-0.581, P<0.05).The areas under the curve (AUC) for ghrelin,D-lactake endotoxin and PCT were 0.868,0.867,0.750 and 0.846.Logistic regression analysis showed that ghrelin,D-lactate,endotoxin and PCT were all risk factors for HFMD. Conclusion Serum ghrelin level is closely related to the severity of HFMD and gastrointestinal function,and decreases with the increasing of severity of HFMD.