川崎病患儿免疫功能的检测及临床价值

Immune function examination and its clinical significance in children with Kawasaki＇s disease

目的总结川崎病（KD）的细胞免疫及体液免疫特征，探讨细胞免疫及体液免疫功能在川崎病发病机制中的作用及临床检测价值。方法速率散射比浊法检测196例川崎病患儿的免疫球蛋白IgG、IgM、IgA、补体c3、c4水平，流式细胞仪免疫荧光法检测T细胞亚群、自然杀伤细胞、B细胞变化。统计学方法采用，检验、2个独立样本的t检验及Spearman等级相关分析。结果196例川崎病患儿中，典型川崎病172例，不完全性川崎病24例，静脉注射免疫球蛋白（WiG）无反应型17例，IVIG敏感型179例，合并冠状动脉病变（CAL）34例；IVIG无反应型川崎病的CAL发生率（52．9％）显著高于IVIG敏感型（14．0％）（X2=16．45，P〈0．05）。与健康对照组相比，急性期川崎病组CDl9细胞绝对值（1165556）／μl、CD4／CD8比值（2．19±0．77）、IgM（1．41±0．45）g／L、IgA（0．81±0．35）g／L、补体c3（1．31±0．26）g／L显著升高（P均〈O．05），CD8细胞（671±308）／μl、自然杀伤细胞（337±233）／LLl绝对值显著降低（P均〈0．05）；川崎病患儿中，IVIG无反应型的CDl9细胞绝对值、CD4／CD8比值、lgM、补体c3水平分别高于IVIG敏感型（P均〈0．05），CD8、自然杀伤细胞绝对值则低于后者（P均〈0．05），合并CAL者的CDl9细胞绝对值、CD4／CD8比值、IgM、IgA水平高于无CAL者（P均〈0．05），CD8、自然杀伤细胞绝对值低于后者（P均〈0．05）；典型川崎病与不完全性川崎病相比，上述各项指标的差异无统计学意义（P均〉0．05）；CAL严重程度分级与急性期CD4／CD8（Th／Ts）比值呈正相关（P〈0．05）。结论川崎病急性期存在细胞及体液免疫功能的紊乱，均参与了川崎病的发病机制，细胞免疫功能紊乱更为显著；其中IVIG无反应型及合并CAL的川崎病免疫紊乱更显著；IVIG无反应型有更高的CAL发生率；CD4／CD8比值与川崎病血管损伤的严重程度有关。

Objective The purpose of the study was to summarize the characteristics of cellular and humoral immunity in children with Kawasaki＇s disease （KD）, and to explore the role of cellular and humoral immunity in the pathogenesis of KD. Methods One hundred and ninety-six subjects with KD were diagnosed and observed. The serum IgG, IgM, IgA and C3, C4 levels were detected by velocity scatter turbidimetry. The levels of T lymphocyte subsets, natural killer ceils （NK cells）, and B cells were analyzed by flow cytometry. Chi-square test, independent t-test and Spearman analysis were adopted to analyze data. Results One hundred and seventy-two cases were diagnosed as typical KD, 24 cases were incomplete KD, 17 cases were refractory KD, 179 cases responded to IVIG therapy, and 34 cases were CAL. The occurrence of coronary artery lesion （CAL） in the refractory KD group was 52.9%, which was evidently higher than those patients responding to IVIG therapy （14.0%, P〈0.05）. In the group of KD, the level of CD19 absolute value （1165±556）μl was higher than that in the control group（P〈0.05）, the ratio of CD4/CD8 （2.19±0.77） was higher than that in the control group（P〈0.05）, the levels of serum IgM （1.41±0.45） g/L, IgA （0.81±0.35） g/L, C3（1.31±0.26） g/L were higher than those in the control group （P〈0.05）, the levels of CD8 （671±308）μ1, NK （337±233）/μ1 absolute value were lower than those in the control group （P〈0.05）. In refractory KD subgroup, the levels of CD19 absolute value, serum IgM, C3 and the ratio of CD4/CD8 were higher than those in the subgroup responding to [VIG therapy（P〈0,05 ）, while the levels of CD8, NK absolute value were lower than those in the latter （P〈0.05）. In the CAL subgroup, the levels of CD19 absolute value, serum IgM, IgA and the ratio of CD4/CD8 were higher than those in the non-CAL subgroup （P〈0.05）, while the levels of CD8, NK absolutevalue were lower than those in the latter （P〈0.05）, The differences of all data between typical KD subgroup and incomplete KD subgroup were insignificant （P〉O.05）. The severity grade of CAL was positively correlated with the ratio of CD4/CD8 （P〈0.05）. Conclusion There are cellular immunity and humoral immunity disturbances in the acute stage of KD, while cellular immunity disturbances are more striking. Cellular immunity and humoral immunity are all involved in the pathogenesis of KD. The immunity dysfunction is more significant in refractory KD and CAL. The occurrence rate of CAL is high in refractory KD. The ratio of CD4/ CD8 is relevant to the severity of vascular injury.