全身型幼年特发性关节炎与川崎病炎症指标的比较

Comparison of inflammatory indexes between systemic onset juvenile idiopathic arthritis and Kawasaki disease

目的比较全身型幼年特发性关节炎(So-JIA)与川崎病(KD)患儿外周血炎症指标水平,为临床诊治提供依据。方法收集73例So-JIA及96例KD患儿的血液标本,测定细胞因子IL-2、IL-4、IL-6、IL-10、TNF—α、IFN—γ及超敏C反应蛋白(hs—CRP)、ESR、血清铁蛋白(SF)等炎症指标的水平,并分析和比较两组的差异。结果与KD组比较,So-JIA组患儿hs—CRP、ESR、SF水平较高,差异均有统计学意义(P=0.010、0.002、0.000),其中以SF最为显著。而IL-4以KD组增高较为显著,差异有统计学意义(P=0.001)。根据临床实用意义及ROC曲线,选取了4个鉴别诊断So-JIA与KD的截断点:当SF为239.5、292.5、385.5、929.5ng/ml时,灵敏度分别为85.4%、79.2%、77.1%、60.4%,特异度分别为76.5%、85.2%、91.4%、98.8%。结论与KD组比较,So-JIA组患儿SF更高,当SF达929.5ng/ml时,So-JIA诊断特异度最高。

Objective To compare inflammatory indexes between Systemic onset juvenile idiopathic arthritis （So-JIA） and Kawasaki disease （KD）. Methods Seventy-three pediatric patients with So-JIA （So-JIA group, n=73） and 96 pediatric patients with KD （KD group, n=96） admitted between January 2013 and March 2014 were included in this study. Serum levels of Jnterleukin-2 （IL-2）, interleukin-4（IL-4）, interleukin-6（IL-6）, interleukin-10（IL-10）, tumor necrosis factor（TNF-α） and interferon gamma （IFN-γ ） were measured by flow cytometry. Other laboratory inflammatory indexes including C-reactive protein（hs-CRP）, erythrocyte sedimentation rate （ESR） and serum ferritin （SF） were also measured in both group. Results The levels of hs-CRP, ESR, SF were higher and IL-4 level was lower significantly in So-JIA group than those in KD group （P=0.010, 0.020, 0.000 and 0.001, respectively）. Taking serum ferritin of 239.5, 292.5, 385.5 or 929.5ng/ml as cut-off values the sensitivity and specificity for differential diagnosis between So-JIA and KD were 85.4%, 79.2%, 77.1%, 60.4% and 76.5%, 85.2%, 91.4%, 98.8%, respectively. Conclusion Serum ferritin level in So-JIA patients is higher than that in KD patients and it may be used for differential diagnosis between two conditions.