柯萨奇B组病毒性心肌炎患儿血清细胞因子变化及其临床意义

Changes of serum cytokines in children with viral myocarditis induced by coxsackie virus type Band its clinical significance

目的探讨柯萨奇B组病毒性心肌炎患儿血清中巨噬细胞移动抑制因子（MIF）、白细胞介素．6（IL．6）、肿瘤坏死因子-α（TNF-α）的变化，及与肌酸激酶同工酶（CK-MB）的关系和临床意义。方法采用酶联免疫吸附（EusA）法检测58例急性期柯萨奇B组病毒性心肌炎患JL（病毒性心肌炎组）和40例同期儿外科住院患儿（对照组）血清MIF、IL-6及TNF．d含量，采用日立7180型全自动生化分析仪检测血清CK．MB。结果病毒性心肌炎组患儿血清MIF、IL-6及TNF．0【含量[（59．154-25．35）、（68．52±12．78）、（85．31±34．18）ng／L]均显著高于对照组[（36．78±12．06）、（28．75±16．03）、（52．91±14．39）ng／L]（P〈0．01）；CK-MB[（46．74±23．89）U／L]亦显著高于对照组[（19．23±11．56）u／L]（P〈0．01）。病毒性心肌炎患儿血清MIF、IL-6、TNF-α与CK-MB均呈正相关（r值分别为0．74、0．63、0．69，P〈0．05）。结论柯萨奇B组病毒性心肌炎患儿存在细胞免疫紊乱，MIF、IL-6及TNF-α可能参与了心肌炎的发病过程，其检测可用于临床判断病情。

Objective To explore the changes of serum macrophage migration inhibitory factor （MIF）, interleukin-6 （IL-6）, tumor necrosis factor-alpha （TNF- ct ） levels, and the relationship with creatine kinase-MB （CK-MB） in children with viral myocarditis induced by coxsackie virus type B,and its clinical significance. Methods Serum MIF, IL-6 and TNF-ct levels were detected by enzyme-linked immunosorbent assay （ELISA） in 58 cases with viral myocarditis induced by coxsackie virus type B in acute phase （viral myocarditis group） and 40 cases hospitalized children （control group）. CK-MB was measured by Hitachi 7180 fully automated clinical chemistry analyzer. Results Serum MIF, IL-6 and TNF-ot levels of viral myocarditis group [ （59.15±25.35 ）, （68.52±12.78）, （85.31±34.18） ng/L] were significantly higher than those of control group[ （36.78± 12.06）, （28.75 ±16.03）, （52.91 ±14.39） ng/L]（P〈 0.01 ）,and CK-MB of viral myocarditis group [（46.74 ＋ 23.89） U/L] was also significantly higher than that of control group [ （ 19.23 ± 11.56 ） U/L ] （P 〈 0.01 ）. There was positive correlation in children with viral myocarditis between MIF, IL-6,TNF-ct and CK-MB （r =0.74,0.63,0.69,P〈0.05）. Conclusions It suggests that immune dysfunction exist in children with viral myocarditis induced by coxsackie virus type B. MIF, IL-6 and TNF-αmight take part in development of mvocarditis, and the detection of them can evaluate severity of myocarditis.