Dynamic changes in serum inflammatory cytokines and their association with neurogenic pulmonary edema in patients with severe hand-foot-mouth disease

Abstract

Objective To investigate the dynamic changes in the serum inflammatory cytokines and their association with neurogenic pulmonary edema (NPE)in the patients with severe hand-foot-mouth disease (HFMD). Methods Eighty-nine patients with severe HFMD from March 2010 to December 2012 were recruited in the study.The patients were divided into NPE group and central nervous system diseases(CNSD) group according whether they had NPE.The cytokines, including interleukin (IL)-4, IL-6, IL-10, IL-17, tumor necrosis factor-α(TNF-α) and interferon-γ(IFN-γ)were evaluated by using enzyme-linked immunosorbent assay on day 1, 3 and 5 after admission to hospital.Risk factors for NPE involvement during hospital stay were analyzed with multivariate Logistic regression analysis. Results (1)Compared with the CNSD group, the serum levels of IL-6(Ftime=1.876, P=0.177, Ftime*group=2.192, P=0.145, Fgroup=7.855, P=0.007), TNF-α(Ftime=13.133, P=0.001, Ftime*group=0.291, P=0.592, Fgroup=3.644, P=0.042), IL-10(Ftime=14.580, P=0.001, Ftime*group=2.612, P=0.078, Fgroup=16.823, P=0.000), INF-γ(Ftime=3.093, P=0.045, Ftime*group= 0.513, P=0.600, Fgroup=20.141, P=0.000)were significantly higher than those in NPE group.(2)The serum levels of TNF-α, IL-10, INF-γ rose to the peak on the third day.(3) By using multivariate Logistic regression analysis, age (OR=3.383, 95% CI: 1.173-4.759), days of fever (OR=4.925, 95%CI: 1.758-3.794), hyperglycaemia (OR=3.465, 95%CI: 1.303-5.220), leucocytosis (OR=7.579, 95%CI: 2.530-12.704)and elevation of IL-10 (OR=1.228, 95%CI: 1.007-1.523) were entered into equation.In the risk evaluation model, these variables remained independent predictors for NPE. Conclusions Abnormal cytokine productions appear to be responsible for the pathogenesis of NPE, and might be an effective tool for predicting NPE in infants with severe HFMD. Key words: Hand-foot-mouth disease; Cytokine; Dynamic change; Neurogenic pulmonary edema