Association between insulin like growth factor-1 and severe hand, foot and mouth disease

doi:10.3877/cma.j.issn.1674-1358.2023.03.002

Abstract

Abstract:

Objective

To investigate the association between insulin like growth factor-1 (IGF-1) and severe disease in children with hand, foot and mouth disease (HFMD).

Methods

Total of 147 children with HFMD hospitalized in Xi’an Children’s Hospital from June 2020 to July 2022 were selected as HFMD case group, who were divided into mild disease group (99 cases) and severe disease group (48 cases) according to the Guidelines for Diagnosis and Treatment of HFMD (2018 edition); while 45 healthy children matching gender and age at the same period were selected as control group. Serum samples of children in each group were collected, and the levels of IGF-1 and other laboratory indicators were detected by enzyme-linked immunosorbent assay (ELISA) method. Clinical data of children in all group were collected. T-test or non-parametric test were used for measurement data, and χ² test was used for counting data. Multiple Logistic regression analysis was performed for indicators that might affect the severity of HFMD, and the receiver operating curve (ROC) was plotted.

Results

Serum IGF-1 level of cases in case group [100.83 (79.12, 127.56) ng/ml] in acute stage was significantly lower than that of control group [133.00 (117.16, 157.85) ng/ml] (Z =-5.867, P < 0.001). Serum IGF-1 level of cases in severe disease group [88.83 (70.97, 100.77) ng/ml] was significantly lower in acute stage than that of mild disease group [113.09 (85.80, 135.36) ng/ml] (Z =-4.484, P < 0.001), with significant differences. After treatment, the level of serum IGF-1 in the mild disease group during convalescence [140.25 (123.45, 154.34) ng/ml] was significantly higher than that in the acute stage [113.09 (85.80, 135.36) ng/ml] (Z =-5.473, P < 0.001). Serum IGF-1 level [(120.93 ± 26.96) ng/ml] of cases in severe disease group in the recovery stage was also significantly higher than that of the acute stage [(87.24 ± 21.17) ng/ml] (t =-6.809, P = 0.025), with significant differences. The level of serum IGF-1 of cases in the severe disease group [123.25 (98.51, 136.65) ng/ml] was still significantly lower than that of the control group, with significant difference (Z = -2.552, P = 0.011). White blood cell (WBC) > 15 × 10⁹/L (χ² = 19.959, P < 0.001), fasting blood-glucose (GLU) > 8.3 mmol/L (χ² = 22.162, P < 0.001), heat range (Z =-7.872, P < 0.001) and neurological symptoms (χ² = 21.475, P < 0.001) were significantly different in severe disease group and mild disease group. ROC analysis showed that the optimal critical value of IGF-1 was 105.83 ng/ml, the sensitivity and specificity were 55.6% and 87.5%, respectively, and the area under the curve was 0.728. Multivariate Logistic regression analysis showed that IGF-1 < 105.83 ng/ml (OR = 9.182, 95%CI: 2.377-35.465, P = 0.001), WBC > 15 × 10⁹/L (OR = 4.836, 95%CI: 1.473-15.871, P = 0.009), fasting blood-glucose > 8.3 mmol/L (OR = 22.109, 95%CI: 2.736-178.664, P = 0.004), thermal range (OR = 2.413, 95%CI: 1.706-3.413, P < 0.001) were all risk factors for severe HFMD.

Conclusions

The level of serum IGF-1 is related to the severity of HFMD, and the decrease of serum IGF-1 level is a risk factor for the progression of HFMD disease, and IGF-1 < 105.83 ng/ml has early warning value for severe HFMD.

Key words: Hand, foot and mouth disease, Insulin-like growth factor-1, Severe

Kaiyue Yan, Huiling Deng, Yufeng Zhang, He Song, Yuan Chen, Miao Xi. Association between insulin like growth factor-1 and severe hand, foot and mouth disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(03): 151-157.

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References 26

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一般资料和临床特征	轻症组（99例）	重症组（48例）	统计量	P值
性别（男/女，例）	58/41	28/20	χ² = 0.001^a	0.977
年龄[M（P25，P75），岁]	1.67（1.00，2.58）	2.00（1.58，2.67）	Z =－1.945	0.052
城市/农村（例）	55/44	27/21	χ² = 0.006^a	0.937
母乳喂养[例（%）]	68（68.69）	31（64.58）	χ² = 0.248^a	0.619
热程[M（P25，P75），d]	2（2，3）	5（4，5）	Z =－7.872	< 0.001
热峰[M（P25，P75），℃]	39.20（38.90，39.80）	39.30（39.10，39.50）	Z =－0.228	0.820
神经系统症状[例（%）]	32（32.32）	35（72.92）	χ² = 21.475^a	< 0.001
循环系统症状[例（%）]			—	—
血压升高	0（0.00）	2（4.17）
循环障碍	0（0.00）	2（4.17）
呼吸系统症状[例（%）]			—	—
呼吸异常^*	0（0.00）	2（4.17）
神经源性肺水肿	0（0.00）	0（0.00）

一般资料和临床特征	轻症组（99例）	重症组（48例）	统计量	P值
性别（男/女，例）	58/41	28/20	χ² = 0.001^a	0.977
年龄[M（P25，P75），岁]	1.67（1.00，2.58）	2.00（1.58，2.67）	Z =－1.945	0.052
城市/农村（例）	55/44	27/21	χ² = 0.006^a	0.937
母乳喂养[例（%）]	68（68.69）	31（64.58）	χ² = 0.248^a	0.619
热程[M（P25，P75），d]	2（2，3）	5（4，5）	Z =－7.872	< 0.001
热峰[M（P25，P75），℃]	39.20（38.90，39.80）	39.30（39.10，39.50）	Z =－0.228	0.820
神经系统症状[例（%）]	32（32.32）	35（72.92）	χ² = 21.475^a	< 0.001
循环系统症状[例（%）]			—	—
血压升高	0（0.00）	2（4.17）
循环障碍	0（0.00）	2（4.17）
呼吸系统症状[例（%）]			—	—
呼吸异常^*	0（0.00）	2（4.17）
神经源性肺水肿	0（0.00）	0（0.00）

指标	轻症组（99例）	重症组（48例）	统计量	P值
WBC > 15 × 10⁹/L [例（%）]	18（18.18）	26（54.17）	χ² = 19.959^a	< 0.001
hsCRP > 5 mg/L [例（%）]	67（67.68）	35（72.92）	χ² = 0.418^a	0.518
PCT [M（P25，P75），ng/ml]	0.17（0.09，0.34）	0.12（0.07，0.24）	Z =－1.573	0.116
空腹血糖> 8.3 mmol/L [例（%）]	2（2.02）	13（27.08）	χ² = 22.162^a	< 0.001
CK-MB > 25 U/L [例（%）]	33（33.33）	18（37.50）	χ² = 0.248^a	0.619
ALT > 30 U/L [例（%）]	8（8.08）	6（12.50）	χ² = 0.733^a	0.392
AST > 44 U/L [例（%）]	9（9.09）	6（12.50）	χ² = 0.410^a	0.522
心电图异常[例（%）]	7（7.07）	7（14.58）	χ² = 2.117^a	0.146
脑电图异常[例（%）]	0（0.00）	19（39.58）	—	—
头颅核磁共振异常[例（%）]	0（0.00）	28（58.33）	—	—

指标	轻症组（99例）	重症组（48例）	统计量	P值
WBC > 15 × 10⁹/L [例（%）]	18（18.18）	26（54.17）	χ² = 19.959^a	< 0.001
hsCRP > 5 mg/L [例（%）]	67（67.68）	35（72.92）	χ² = 0.418^a	0.518
PCT [M（P25，P75），ng/ml]	0.17（0.09，0.34）	0.12（0.07，0.24）	Z =－1.573	0.116
空腹血糖> 8.3 mmol/L [例（%）]	2（2.02）	13（27.08）	χ² = 22.162^a	< 0.001
CK-MB > 25 U/L [例（%）]	33（33.33）	18（37.50）	χ² = 0.248^a	0.619
ALT > 30 U/L [例（%）]	8（8.08）	6（12.50）	χ² = 0.733^a	0.392
AST > 44 U/L [例（%）]	9（9.09）	6（12.50）	χ² = 0.410^a	0.522
心电图异常[例（%）]	7（7.07）	7（14.58）	χ² = 2.117^a	0.146
脑电图异常[例（%）]	0（0.00）	19（39.58）	—	—
头颅核磁共振异常[例（%）]	0（0.00）	28（58.33）	—	—

组别	例数	性别（男/女，例）	年龄[M（P25，P75），岁]	IGF-1 [M（P25，P75），ng/ml]
病例组	147	86/61	1.92（1.17，2.67）	100.83（79.12，127.56）
对照组	45	22/23	2.17（1.29，3.04）	133.00（117.16，157.85）
统计量		χ² = 1.294	Z =－1.665	Z =－5.867
P值		0.255	0.096	< 0.001

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