川崎病患儿血清MMP-9、TIMP-1、ET-1水平的变化及其临床意义

Changes of Serum Matrix Metalloproteinase 9,Tissue Inhibitor of Matrix Metalloproteinase 1,Endothelin-1 in Kawasaki Disease and Their Clinical Significance

目的探讨川崎病(KD)患儿不同时期血清基质金属蛋白酶(MMP-9)、组织基质金属蛋白酶抑制物(TIMP-1)、内皮素-1(ET-1)水平的变化及其与冠状动脉病变之间的关系。方法采用酶联免疫吸附法(ELISA)、放免法(RIA)对34例KD患儿急性期、治疗后5d、亚急性期和恢复期血清MMP-9、TIMP-1、ET-1水平进行检测,并与34例正常健康儿童进行对照。同时应用心脏彩超检测KD患儿冠状动脉的病变。结果KD患儿不同时期血清MMP-9、TIMP-1、ET-1水平及MMP-9/TIMP-1比值组间有差异。KD患儿血清MMP-9、TIMP-1、MMP-9/TIMP-1及ET-1(292.56±28.65)μg/L、(394.50±46.80)μg/L、(0.75±0.11)、(80.65±14.00)pg/ml均明显高于正常对照组(27.53±11.67)μg/L、(100.47±32.96)μg/L、(0.28±0.10)、(52.70±11.39)pg/ml,其中冠脉扩张组血清MMP-9/TIMP-1显著高于无扩张组,且与冠脉扩张程度呈正相关(r=0.83),而扩张组血清MMP-9、ET-1水平与无扩张组之间无显著差异,血清TIMP-1水平低于无扩张组。结论血清MMP-9、TIMP-1、ET-1可能参与了川崎病的病理发病机制,血清MMP-9/TIMP-1持续失衡,可作为预测川崎病并发冠状动脉炎,尤其是冠状动脉扩张的生化指标之一。

Objective To assess the clinical significance of serum matrix metalloproteinase 9（ MMP-9）, tissue inhibitor of matrix metalloproteinase I（TIMP-1）, endothelin-1 （ET-1） in Kawasaki disease（KD） and its complication of coronary arterial lesions （ CAL）. Methods Serum contents of MMP-9, TIMP-1 and ET-1 in different stages were measured in 34 KD children by ELISA and RIA . The coronary echocardiography was also done. Results Serum contents of MMP-9, TIMP-1 and ET-1 in KD in different stages had significant difference. Serum contents of MMP-9, TIMP-1 and ET-1 in KD were higher than those in control group; in KD children with CAL, Serum MMP-9/TIMP-1 was apparently higher than that in KD children without CAL; and the serum MMP-9/TIMP-1 and the CAL had positive correlation. Serum contents of MMP-9, ET-1 had no sig- nificant difference between KD children with CAL and without CAL. Serum content of TIMP-1 in KD children with CAL was significantly lower than that in KD children without CAL. Conclusion MMP-9, TIMP-1 and ET-1 synergically take part in the pathogenesis of KD. MMP-9/TIMP-1 may act as a marker to predict the inflammation of coronary artery, especially the dilatation of coronary artery.