The clinical value of aquaporin-4 in children with hand, foot, and mouth disease and the effect of magnesium sulfate on its expression: a prospective randomized clinical trial
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To evaluate the clinical value of aquaporin-4 (AQP-4) in hand, foot, and mouth disease (HFMD) and to evaluate therapeutic efficacy of magnesium sulfate (MgSO4) and its effect on AQP-4 expression. Children with HFMD were divided into a common group, a severe group and a critical group according to Chinese guidelines; children in the critical group were further divided into two subgroups: routine treatment group and MgSO4 group. Outcome measures included systolic blood pressure (SBP), Heart rate (HR), the levels of AQP-4, interleukin-6 (IL-6), norepinephrine (NE), and neuron-specific enolase (NSE). Serum AQP-4, IL-6, NE, and NSE levels varied significantly among the critical, severe, and common groups before and after treatment. There were no significant differences in AQP-4 levels in cerebrospinal fluid (CSF) between the critical and severe groups before and after treatment; however, CSF AQP-4 levels in these two groups were higher than those in the common group before treatment. Serum and CSF AQP-4 levels in convalescence decreased significantly in the critical and severe groups. SBP, HR and serum AQP-4, IL-6, NE, NSE levels, but not CSF AQP-4 levels, were significantly lower in MgSO4 group than in the routine treatment group. AQP-4 in serum, but not in CSF, is a candidate biomarker for evaluating the severity and prognosis of HFMD; MgSO4 can provide protection on children with critical HFMD.
KeywordsHand, foot, and mouth disease Aquaporin-4 Magnesium sulfate Cerebral injury
The authors thank Ke Wang from Xuzhou Medical University, Xuzhou, China, for his assistance in the protocol review and statistical analyses.
Lei Zhu, Hong Yin, and Bixiang Qi conceived the study. Lei Zhu, Hong Yin, Haomiao Sun, and Boxiang Qi participated in the study design. Gongjian Qi and Junling Zhu participated in the statistical design. Tong Qian and Ying Wang conducted the study, including acquisition, detection, analysis, and interpretation of data. Gongjian Qi and Hong Yin completed the statistical analysis and data interpretation. All authors critically reviewed, edited, and approved the manuscript and made the decision to submit for publication. All authors assume responsibility for the accuracy and completeness of the data.
This study was funded by the Jiangsu Provincial Commission of Health and Family Planning (Q201617), and Xuzhou Science and Technology Planning (KC16SL140).
Compliance with ethical standards
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.
The authors declare that they have no competing interests.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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