NF-κB、MMP-9的表达水平与川崎病患儿心血管损害预测价值

predictive value of NF-κB and the expression of MMP-9 on cardiovascular damage in children with Kawasaki disease

目的:探讨核细胞核因子-κB(NF-κB)、基质金属蛋白酶9(MMP-9)的表达水平对预测川崎病患儿心血管损害的价值。方法:选取98例被确诊为川崎病的患儿作为川崎病组;选取同期的59例上呼吸道感染患儿作为阳性对照;再选取45例体检健康的正常儿童作为健康对照组,比较三组对象的临床指标并进行ROC曲线分析。结果:三组川崎病患儿的首次应用静脉注射用丙种球蛋白的时间、唇及口腔改变、NF-κB、MMP-9及ALT等水平组间比较差异显著有统计学意义(F=4.56,P=0.000;F=1.63,P=0.014;F=6.12,P=0.000;F=7.78,P=0.000;F=5.99,P=0.000)。心血管损害组的61例川崎病患儿的年龄、首次应用静脉注射用丙种球蛋白的时间、NF-κB、MMP-9、HDL-C及ALT等水平与心血管无损害组的37例患儿比较差异显著有统计学意义(t=4.986,P=0.000;t=5.736,P=0.000;t=33.705,P=0.000;t=54.355,P=0.000;t=66.292,P=0.000;t=11.581,P=0.000)。当NF-κB≥788.5 ng·L^(-1)时,鉴别是否发生心血管损害的敏感性达88.2%,特异性达85.6%;当MMP-9≥696.5 ng·L^(-1)时,鉴别是否发生心血管损害的敏感性达87.5%,特异性达86.8%。当NF-κB的诊断临界点788.5 ng·L^(-1)≥且MMP-9≥696.5 ng·L^(-1)时,鉴别是否发生心血管损害的特异性达92.0%。结论:NF-κB、MMP-9的表达水平在川崎病患儿心血管损害中可起到对心血管损害有效预测的价值。

Objective： To discuss nuclear factor-κB（ NF-κB）,matrix metalloproteinase-9（ MMP-9） expression levels in predicting cardiovascular damage in children with Kawasaki disease. Methods： This study included 98 children diagnosed with Kawasaki disease as Kawasaki disease group; 59 cases of respiratory tract infections in children during the same period as positive controls; 45 cases of normal children as healthy controls. Clinical indicators and ROC curve were analyzed. Results： The time of first application of intravenous gamma globulin,the lip and oral changes the level of NF-κB,MMP-9 had difference between the three groups（ F = 4. 56,P = 0. 000;F = 1. 63,P = 0. 014; F = 6. 12,P = 0. 000; F = 7. 78,P = 0. 000; F = 5. 99,P = 0. 000）. For 61 cases children with Kawasaki,their cardiovascular damage,the first application of intravenous gamma globulin time,NF-κB,MMP-9,HDL-C and ALT levels were different from those of 37 children without risk of damage（ t = 4. 986,P = 0. 000; t =5. 736,P = 0. 000; t = 33. 705,P = 0. 000; t = 54. 355,P = 0. 000; t = 66. 292,P = 0. 000; t = 11. 581,P =0. 000）. When NF-κB≥788. 5 ng·L-1,the sensitivity to identify whether the occurrence of cardiovascular damage was 88. 2% with a specificity of 85. 6%; When MMP-9 ≥696. 5 ng ·L-1,the sensitivity to identify whether the occurrence of cardiovascular damage amounted to 87. 5% with a specificity of 86. 8%. When the NF-κB reached the critical point 788. 5 ng·L-1≥ and MMP-9 ≥696. 5 ng·L-1,the specificity for the occurrence of cardiovascular damage was 92. 0%. Conclusion： NF-κB,MMP-9 expression levels of cardiovascular damage in children with Kawasaki disease can predict cardiovascular damage.