氧化型低密度脂蛋白在早期预测川崎病冠状动脉损害中的价值

Early prediction of the risk of coronary artery lesions in K awasaki disease by oxidized low-density lipoproteins

目的观察川崎病急性期血浆氧化型低密度脂蛋白（oxLDL）的表达，探讨oxLDL在早期预测川崎病冠状动脉损害中的价值。方法确诊为川崎病的患儿80例，根据不同时期超声结果分为4组：急性期、亚急性期均有冠状动脉损害组（CAL1组）8例、急性期有冠状动脉损害，亚急性期恢复正常组（CAL2组）10例；急性期冠状动脉正常，亚急性期出现冠状动脉损害组（NCAL1组）10例和急性期和亚急性期均无冠状动脉损害组（NCAL2组）52例。于急性期（静脉丙种球蛋白使用前）采集静脉血。同时收集本院住院的发热患儿及门诊体检的健康儿童各20名为发热对照组和健康对照组，采集静脉血。血浆oxLDL浓度检测采用双抗体夹心固相ELISA，均数比较采用单因素方差分析，两两比较用LSD—t检验。并行受试者工作特征曲线（ROC曲线）分析确定界限值。结果川崎病患儿急性期无论有无冠状动脉损害血浆oxLDL含量均高于对照组，差异有统计学意义[CAL组（15．0±3．3）mU／L，NCAL组（12．3±3．5）mU／L与发热对照组（9．2±2．2）mU／L，健康对照组（8．0±2．3）mU／L；F=20．435，P〈0．05]。与冠状动脉无损害的川崎病患儿相比，有冠状动脉损害患儿血浆oxLDL升高更为明显[（15．0±3．3）mU／L与（12．3±3．5）mU／L，t=2．89，P=0．002]。川崎病各组间比较差异有统计学意义（F=5．068，P=0．003），NCAL1组与NCAL2组相比血浆oxLDL含量升高，差异有统计学意义[（14．5±3．8）mU／L与（11．9±3．3）mU／L，t=2．29，P=0．02]，而与急性期即有冠状动脉损害的CAL1组[（15．9±3．9）mU／L]、CAL2组[（14．2±2．7）mU／L]比较差异无统计学意义（t值分别为0．73和0．20，P分别为0．41，0．84）]。ROC曲线分析oxLDL≥13．83mU／L时，预测冠状动脉损害的灵敏度为0．607，特异度为0．75。结论oxLDL在川崎病冠状动脉损害中具有一定作用；川崎病冠状动脉内皮功能障碍早于冠状动脉扩张，oxLDL有望成为早期预测川崎病冠状动脉损害的一个可靠指标。

Objective To study the expression of plasma oxidized low-density lipoprotein （oxLDL） in children with acute phase Kawasaki disease （KD）, and investigate its value for early prediction of coronary artery lesions in KD. Methods Totally 80 children with KD were collected. Children were divided into four groups by the results of echocardiogram of coronary artery in different periods： CALl group （children with coronary artery lesions （CAL＋） both in acute and sub-acute phase, 8 cases）, CAL2 group （children with CAL＋ in acute phase but recovery normal （CAL-） in sub-acute phase, 10 cases）, NCAL1 group （children with CAL- in acute phase but occur CAL＋ in sub-acute phase, 10 cases） and NCAL2 group （children with CAL- both in acute and sub-acute phase, 52 cases）. The serum samples （before the use of intravenous immunoglobulin） were collected in acute phase. Twenty healthy controls and twenty fever controls were enrolled into the study, and their serum samples were collected. OxLDL was measured by enzyme linked immunosorbent assay （ELISA）. They were compared using ANOVA, pairwise comparison LSD-t test. And ROC curve analysis was used todetermine the threshold. Results Compared with the control groups,plasma oxLDL levels were higher in children with KD, both CA＋ and CAL- [（15.0±3.3） mU/L, （12.3±3.5） mU/L vs （9.2±2.2） mU/L, （8.0±2.3） mU/L, F=20.435, P〈0.05]. Plasma oxLDL levels were increased more significantly in children with CAL＋ than children with CAL- in KD [（15.0±3.3） mU/L vs （12.3±3.5） mU/L, t=2.28, P=0.002]. There was significant difference in the concentration of oxLDL between the groups of Kawasaki disease （F=5.068, P=0.003）. Plasma oxLDL levels were significantly higher in the NCAL1 group than those in the NCAL2 group [（14.5±3.8） mU/L vs （11.9±3.3） mU/L, t=2.29, P=-0.02], but there were no statistically significant difference between the NCAL1 group and CALl or CAL2 group [（14.5±3.8） mU/L vs （15.9±3.9） mU/L, （14.5±3.8） mU/L vs （14.2±2.7） mU/L, t=0.73, 0.20; P=0.41, 0.84]. ROCs analysis indicated that oxLDL≥ 13.83 mU/L, could be the threshold for the prediction of coronary artery lesions with the sensitivity of 0.607 and a specificity of 0.75. Conclusion OxLDL plays an important role in coronary.artery lesions in KD. The coronary endothelial dysfunction is earlier than coronary dilatation, and oxLDL is expected to become a reliable early predictor of coronary artery lesions in KD.