Expression of Aquaporin 4 in Enterovirus 71-Infected Hand-Foot-Mouth Disease and Effect of Magnesium Sulfate Intervention on Its Expression: A Prospective Randomized Controlled Study

Abstract

Background: This study was approved to evaluate the clinical significance of aquaporin 4(AQP-4) expression in EV71-infected hand-foot-mouth disease (HFMD) and observe the effect of magnesium sulfate(MgSO4) intervention on AQP-4. Methods: Children with EV71-infected HFMD were divided into common group, severe group and critical group according to the severity of the disease. And the children in critical group were further randomly divided into the routine treatment group and MgSO4 group. The MgSO4 group was given intravenous of MgSO4 in addition to routine treatment. Outcome measures included the levels of AQP-4, interleukin-6 (IL-6), norepinephrine (NE), neuron-specific enolase (NSE) before and after treatment. Results: There was no significant difference in AQP-4 of cerebrospinal fluid (CSF) between critical group and severe group, but its levels in the both groups were higher than that in common group. The AQP-4 in serum showed significant difference between critical group, severe group and common group. After treatment, the AQP-4 in serum and CSF was significantly decreased in both critical and severe group . Compared with the routine treatment group, the AQP-4, IL-6, NE and NSE levels in serum were significantly lower after MgSO4 intervention, but the AQP-4 in CSF showed no significant difference between these two treatment groups. Conclusions: AQP-4 in serum can be used as an index to determine the disease conditions and prognosis for EV71-infected HFMD. The neuroprotective effect of MgSO4 on critical HFMD is not mediated by AQP-4 pathway directly. Clinical Trial Number: Chinese Clinical Trial Registry, ChiCTR-INR-17010564. Funding Statement: This study is funded by Youth Project-Jiangsu Provincial Commission of Health and Family Planning (Q201617), Xuzhou Science and Technology Planning Project (KC16SL140) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was conducted in accordance with the ethical principles stated in the Declaration of Helsinki and chinese regulatory requirements, and the study was approved by the Hospital Medical Ethics Committee with the informed consent of the parents of the children.