皰疹性咽峽炎與G6PD缺陷的關(guān)系

陳寶伶

【摘要】 目的：探討葡萄糖-6-磷酸脫氫酶（glucose-6-phosphate dehydrogenase， G6PD）與皰疹性咽峽炎的關(guān)系，分析可能的機(jī)制。方法：選取本院2016年6月-2017年5月確診為皰疹性咽峽炎患兒60例為觀察組，同期體檢的62例健康兒童為對(duì)照組。用全自動(dòng)生化儀測(cè)定血液中G6PD值，觀察記錄觀察組患兒G6PD活性正常組與缺乏組的總熱程、心肌酶異常情況、住院天數(shù)。結(jié)果：觀察組G6PD缺陷比例明顯高于對(duì)照組（P<0.01）。觀察組G6PD缺乏患兒總熱程、心肌酶異常情況及住院天數(shù)均較G6PD正常者長(zhǎng)，比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：G6PD缺陷增加皰疹性咽峽炎的易感性，伴有G6PD缺乏的患兒病情更嚴(yán)重，其原因可能與氧化應(yīng)激有關(guān)。

【關(guān)鍵詞】 皰疹性咽峽炎； 葡萄糖-6-磷酸脫氫酶； 兒童

【Abstract】 Objective：To study the relationship between glucose-6-phosphate dehydrogenase（G6PD） deficiency and Herpangina，analyze the possible mechanisms.Method：A total of 60 children with herpangina were collected from June 2016 to May 2017 in our hospital as the observation group，and 62 healthy children in the same period were selected as the control group.Determination of the activity of G6PD in blood by automatic biochemical analyzer，the total heat course，abnormal myocardial enzyme and hospitalization days of G6PD activity in normal group and deficient group were observed and recorded.Result：The percentage of G6PD deficiency cases in observation group was apparently higher than the control group（P<0.01）. In observation group，the total heat，abnormal myocardial enzyme and hospitalization days of G6PD activity in deficient group were higher than normal group，the differences were statistically significant（P<0.05）.Conclusion：G6PD deficiency fortifies susceptibility of Herpangina and aggravate the patients condition.Its mechanism might be related to oxidative stress.

【Key words】 Herpangina； Glucose-6-phosphate dehydrogenase deficiency； Child

First-authors address：The Third Peoples Hospital of Dalian，Dalian 116033，China

doi：10.3969/j.issn.1674-4985.2017.31.030

皰疹性咽峽炎是兒科常見病，為小兒急性上呼吸道感染的一種特殊類型。引起皰疹性咽峽炎的病原體主要是柯薩奇病毒A組[1]，也可見于腸道埃可病毒，雖然以夏、秋兩個(gè)季節(jié)為主，但全年中仍有散發(fā)病例，且傳染性非常強(qiáng)，流行性發(fā)病明顯，發(fā)病以嬰幼兒居多，臨床表現(xiàn)主要是急起高熱、納差、厭食、嘔吐、流涎、皰疹、潰瘍、厭食、嘔吐、咽痛等， 部分病例可并發(fā)腹瀉、肺炎、心肌損害、肝臟損害、病毒性腦炎等情況[2-4]。體檢時(shí)可以發(fā)現(xiàn)咽部出現(xiàn)數(shù)個(gè)灰白色皰疹，部分破潰，變成潰瘍，嚴(yán)重者可引起重要臟器功能損傷，且在嬰幼兒期易發(fā)生嘔吐和驚厥。葡萄糖-6-磷酸脫氫酶（glucose-6-phosphate dehydrogenase，G6PD）缺乏多見于我國(guó)南方，尤其是廣東、廣西地區(qū)，是誘發(fā)溶血性貧血主要原因之一，故社會(huì)群體對(duì)于G6PD缺乏十分重視。目前研究證明：病毒感染可引發(fā)宿主細(xì)胞出現(xiàn)氧化反應(yīng)，導(dǎo)致細(xì)胞功能和結(jié)構(gòu)受到損傷[5-6]，而G6PD可以減少氧化損害[7]。缺乏G6PD的細(xì)胞易受病毒感染，機(jī)體感染后，出現(xiàn)氧化應(yīng)激使細(xì)胞受損，進(jìn)而使病毒感染毒力增強(qiáng)，細(xì)胞發(fā)生病理改變[8-10]。……