静脉注射丙种球蛋白治疗对急性期川崎病IgGFc受体和TLR4表达的影响

The effects of intravenous immunoglobulin on the expression of IgGFc receptor and TLR4 in childrenwith acute Kawasaki disease

目的探讨静脉注射丙种球蛋白（intravenous immunoglobulin，IVIG）治疗对川崎病（Kawasaki disease，KD）Toll样受体4（Toll-like receptor4，TLR4）表达的影响。方法急性KD患儿25例，正常同龄对照儿童15例。流式细胞术检测单核细胞（monocyte cells，MC）1]LR4表达水平；双抗体夹心酶联免疫吸附试验（ELISA）检测血浆TNF-α 浓度；反转录．聚合酶链反应（RT．PCR）及荧光定量PCR检测MC聊RIIb、TLR4信号转导途径分子（MyD88、TRAF-6、TAKl）和细胞因子（IL-1B、IL-6、TNF-α）mRNA表达。结果急性期KD患儿MCTLR4及其转导分子表达明显高于同龄对照组（P〈0．05），IVIG治疗后较治疗前明显降低（P〈0．05）；急性期KD患儿MCFeaRⅡb明显低于同龄对照组（P〈0．05），IVIG治疗后明显升高（P〈0．05）；急性期KD患儿IL-1B、IL-6、TNF．仪表达及血浆TNF-α 浓度显著增高（P〈O．05），IVIG治疗后下降（P〈0．05）；急性期KD患儿MCFcyRⅡb表达与TLR4表达及炎症细胞因子呈相关性（P〈0．05）。结论IVIG可能上调Fcγ／R11b表达，下调TLR4表达，从而抑制炎症反应。

Objective To investigate the effects of the intravenous immunoglobulin （IVIG） on the expression of FcγR 11＂ b and Toll-like receptor 4 （TLR4） in children with Kawasaki disease （KD）. Methods 25 children with KD and 15 healthy controls were enrolled in this study. The levels of TLR4 expression on monocytes were assessed by flow cytometry. Real-time PCR was performed to detect the transcription levels of FcγR 11 b, TLR4 signaling molecules （ MyD88, TRAF-6, TAK1 ） and cytokines （ IL-1 β, IL-6, TNF-α） in monocytes. The concentrations of TNF-ot in plasma was determined by enzyme-linked immunosorbent assay （ELISA）. Results （ 1 ） Compared with healthy controls, the expression of TLR4 and the signaling molecules in the patients were significantly up-regulated but decreased after treatment with IVIG （P〈O. 05）. （2） The levels of FcγR I1 b expression from the patients were higher than those from healthy controls, and decreased after treatment with IVIG（ P〈0.05 ）. （ 3 ） The levels of cytokine factor expression such as IL-Iβ, IL-6 and TNF-α in the patients were found to be higher than those in healthy controls（P〈O. 05） ; plasma concentrations of TNF-α were significantly elevated during acute KD （P〈0.05）. （4）There were significantly correlations to follow between Fc~/R I1 b and the levels of cytokine, TLR4 expression in monocytes （ P〈 O. 05）. Conclusion IVIG can up regulate Fc^cR 11 b expression and down regulate TLR4 expression which might inhibit the inflammatory response.