[The exploration of the role of angiopoietin-2 in pulmonary edema induced by EV71 infection].
OBJECTIVE
To observe the clinic character of pulmonary edema (PE) induced by enterovirus 71 (EV71) and the change in angiopoietin-2 (Ang-2), and to explore the correlation between Ang-2 and PE.


METHODS
Twenty consecutive infants with PE induced by EV71 admitted to intensive care unit (ICU) of Binzhou Medical College Affiliated Hospital from May 2011 to September 2013 were prospectively enrolled in PE group; 20 infants with similar age infected by EV71 without PE and hospitalized in ICU were enrolled as non-PR group; and 20 similar age infants suffering from selective inguinal hernia operation were served as control group. Data of infants with or without PE were collected including vital signs, complete blood count, blood biochemistry tests, chest X-ray and cerebrospinal fluid at ICU admission. Pulmonary edema liquid and serum were collected from infants suffered from severe PE by tracheal intubation. Total protein, albumin and Ang-2 [enzyme linked immunosorbent assay (ELISA)] were determined and those of pulmonary edema liquid/serum (P/S) ratio were calculated.


RESULTS
Nine infants with PE died, and all of infants without PE survived. Body temperature, heart rate, blood pressure, white blood cell count (WBC), blood sugar and MD isoenzyme of creatine kinase (CK-MD) in EV71 infection infants were higher than those in controls, and albumin and oxygenation index (PaO(2)/FiO(2)) were lowered. Heart rate, blood sugar and WBC of infants with PE were significantly higher than those of infants without PE [heart rate (bmp): 181 ± 31 vs. 146 ± 19, t=3.397, P=0.003; blood sugar (mmol/L: 14.9 ± 9.8 vs. 6.3 ± 1.5, t=2.793, P=0.012; WBC (x10(9)/L): 22.1 ± 9.8 vs. 10.2+3.6, t=3.579, P=0.002], and serum albumin and PaO(2)/FiO(2) of infants with PE were significantly lower [albumin (g/L): 33.6+5.9 vs. 42.7 ± 2.9, t=3.258, P=0.004; Pa(2)/FiO(2) (mmHg, 1mmHg=0.133 kPa): 142 ± 76 vs. 396 ± 39, t=3.927, P=0.000]. Cerebrospinal fluid pressure was significantly elevated in both non-PE and PE groups, the number of nucleated cells were normal or mildly to moderately elevated, most were mononuclear cells, and protein content were normal. Ang-2 levels of infants with PE [236.17 (167.63, 366.65) ng/L] was higher than that of control infants [19.67 (8.72, 33.68) ng/L] and infants without PE [23.46 (13.28, 46.77) ng/L, both T=210, both P=0.000]. Pulmonary edema liquid was collected from 8 infants with severe PE. Total protein, albumin, lactate dehydrogenase (LDH) and Ang-2 in severe PE infants were elevated. Total protein of P/S ratio was 0.67, 1.33, 1.12, 0.72, 0.84, 0.73, 1.09, 1.24, albumin of P/S ratio was 0.72, 1.64, 0.84, 0.87, 1.06, 0.92, 1.12, 1.48, LDH of P/S 0.92, 1.03, 1.17, respectively.


CONCLUSIONS
Pulmonary edema liquid of infants with PE induced by EV71 infection os rich of protein, and Ang-2 level rises in serum and pulmonary edema liquid. Ang-2 may involve in pulmonary vascular leak and developments of PE.
Li
L
Zhi
Hao
H
Dong
Wang
W
Tao
Gao
G
Fuquan
Ning
N
Fangyu
Xia
X
Yongfu
Wang
W
Xiaozhi
D042702:Angiopoietin-2 / Q000097:blood*; D004770:Enterovirus; D029821:Enterovirus A, Human; D004769:Enterovirus Infections / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000097:blood* / Q000821:virology*
C586513:ANGPT2 protein, human; D042702:Angiopoietin-2