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| The investigation of changes in serum cortisol and thyroid hormone in children with severe hand,foot and mouth disease |
| XIONG Yan-Yan, XU Nan-Ping, LI Yi, LU Juan, HU Yu |
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Abstract Objective To investigate the changes in serum cortisol（COR）, adrenocorticotropic hormone（ACTH）and thyroid hormone（TH）of children with severe hand- foot- and- mouth disease（HFMD）, and provide references for early assessment and rational use glucocorticoid in critical patients with severe HFMD. Methods Ninety patients with severe HFMD hospitalized in emergency ward（HFMD ward）and PICU of Jiangxi Children’s Hospital were selected from March 2014 to June 2015. According to 2011 version of the expert consensus of clinical staging criteria, the patients were divided into three groups: group A（stage 2）, group B（stage 3）and group C（stage 4）; there were 30 cases in each group.The next morning after admission, fasting venous blood was taken and the levels of COR, ACTH and TH in 3 groups were measured by chemiluminescence immunoassay. Results ①The COR levels of children with severe HFMD in stage 2, 3 and 4 were higher than normal value（4.3～22.41 μg/dL）; the COR and ACTH levels of children in stage 4 were significantly higher than that of children in stage 2 and 3;the difference was statistically significant（P＜0.05）. ②The levels of free three iodine thyroid original ammonia acid（FT3）in children with HFMD in stage 2, 3 and 4 were lower than normal value（3.37～7.98 pg/mL）, and the free thyroxine（FT4）and thyroid stimulating hormone（TSH）levels in stages 3 and 4 of children with HFMD were lower than that of stage 2（P＜0.05）. ③With serum COR and ACTH levels of children in different stages increased，and the level of thyroid hormone decreased; the length of hospital stay, duration of fever, duration of mechanical ventilation and blood pressure recovery time were significantly prolonged; and the cure rate was reduced. ④71.11% of severe HFMD children complicated with euthyroid sick syndrome（ESS）. ⑤The duration of fever of children with glucocorticoid therapy in stages 2, 3 and 4 were significantly shorter than that of unused hormone treatment group（P＜0.05）;compared large dose of hormone［10～15 mg/ （kg·d）］treatment group in stages 2, 3 with low dose hormone［1～2 mg/ （kg·d）］treatment group and unused hormone therapy group，the hospitalization days,startle duration and the cure rate were no statistically significant difference（P＞0.05）. ⑥Although hospitalization days and startle duration in stage 4 between large dose hormone therapy group and low dose hormone group was not significantly different（P＞0.05）, but the cure rate of small dose glucocorticoid group in stage 4 was higher than that of the large dose of group（P＜0.05）. Conclusion ①The more severe the children HFMD is, the higher the levels of COR and ACTH, and the lower levels of the FT3,FT4 and TSH are. ② Hospitalization days and startle duration with glucocorticoid therapy cannot be shorten, except for fever duration of children with HFMD. The effect of small dose glucocorticoid therapy group in stage 4 is better than that of large dose of glucocorticoid.
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Received: 28 April 2016
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