川崎病患儿血清趋化素和缺血修饰清蛋白水平与冠状动脉损伤的相关性及在治疗中的应用价值

Relationship between the Levels of Chemokine and Ischemia-modified Albumin in Serum and Coronary Artery Injury in Children with Kawasaki Disease and the Application Value in the Treatment

目的探讨血清趋化素(Chemerin)和缺血修饰清蛋白(Ischemia-modified albumin,IMA)水平与川崎病(Kawasaki disease,KD)患儿冠状动脉损伤的相关性及在治疗中的应用。方法选取2014年8月~2019年8月在咸阳市第一人民医院、陕西省森工医院和咸阳市妇幼保健院就诊的75例KD患儿作为研究对象。依据患儿超声心动图结果分为冠状动脉正常组(normal coronary artery,NCA)48例组和冠状动脉病变组(Coronary artery disease,CAD)27例,选取32例同期体检健康者作为对照组。KD患儿血清Chemerin水平检测采用酶联免疫吸附试验法。IMA水平检测采用清蛋白-钴结合法。通过彩色多普勒超声检查分析KD患儿的冠状动脉左主干(left main coronary artery,LMCA)内径,左前降支(left anterior descending coronary artery,LADC)内径及右冠状动脉近端(proximal right coronary artery,PRCA)内径。比较分析以上指标的变化与KD患儿冠状动脉损伤的相关性。结果对照组和NCA组患儿治疗后和治疗前,CAD组患儿治疗后和治疗前的血清Chemerin和IMA水平分别为203.32±26.37,247.50±36.42,317.50±52.16,279.21±45.63,356.89±59.28ng/ml和41.20±11.37,55.39±17.45,76.36±26.18,69.50±22.23,92.67±33.49U/ml。NCA组和CAD组患儿治疗前的Chemerin和IMA水平与对照组比较明显增高,其中CAD组增高更显著。NCA组和CAD组患儿治疗后的Chemerin和IMA水平与对照组比较明显增高,其中CAD组增高更显著,差异均有统计学意义(F=31.50~36.10,均P=0.000)。CAD组患儿治疗前的血清Chemerin和IMA水平分别与LMCA内径、LADC内径和PRCA内径呈正相关性(rChemerin=0.693,0.652,0.637,均P<0.01;rIMA=0.669,0.620,0.619,均P<0.01)。结论IMA和Chemerin可能与KD的发生发展密切相关。检测IMA和Chemerin水平可以为KD的诊治及冠状动脉损伤的评估提供依据。

Objective To explore the relationship between the levels of Chemokine and Ischemia-modified albumin(IMA)in serum and the coronary artery injury in children with Kawasaki disease(KD)and its application in treatment.Methods 75 children with KD who were treated in the First People’s Hospital of Xianyang City,Shaanxi Forest Industry Hospital and the Maternal and Child Health Hospital of Xianyang City from August 2014 to August 2019 were selected as the research objects.According to the results of echocardiography,they were divided into normal coronary artery(NCA,48 cases)group and coronary artery disease(CAD,27 cases)group.32 healthy persons in the same period were selected as the control group.The serum level of chemerin in KD children was detected by enzyme-linked immunosorbent assay.The level of IMA was detected by albumin cobalt junction method.The diameter of left main coronary artery(LMCA),left anterior descending coronary artery(LADC)and right proximal coronary artery(PRCA)were analyzed by color Doppler ultrasound.The correlation between KD and the changes of LADC and PRCA was analyzed.Results After and before treatment in NCA group and in CAD goup,the levels of chemorin and IMA were 203.32±26.37,247.50±36.42,317.50±52.16,279.21±45.63,356.89±59.28ng/ml and 41.20±11.37,55.39±17.45,76.36±26.18,69.50±22.23,92.67±33.49U/ml repectively in the control group.The levels of chemorin and IMA in NCA group and CAD group before treatment were significantly higher than those in the control group,especially in CAD group.The levels of chemorin and IMA in NCA group and CAD group after treatment were significantly higher than those in the control group,especially in CAD group.The differences between the above comparisons were statistically significant(F=31.50~36.10,all P=0.000).There was a positive correlation for the serum levels of chemorin and IMA before treatment with the inner diameter of LMCA,LADC and PRCA,respectively,(rchemorin=0.693,0.652,0.637,all P<0.01;rIMA=0.669,0.620,0.619,all P<0.01).Conclusion IMA and Chemerin could be closely related to the occurrence and development of KD.The detection of IMA and Chemerin can provide a basis for the diagnosis and treatment of KD and the assessment of coronary artery injury.