细胞因子谱、降钙素原、D-二聚体对预测小儿川崎病冠脉损伤的临床意义

The clinical significance of cytokine profiles,procalcitonin and D-dimer in predicting coronary artery injury of children Kawasaki disease

目的探讨细胞因子谱、降钙素原(PCT)、血浆D-二聚体(D-D)与川崎病冠状动脉损伤(CAL)的相关性。方法 61例川崎病患儿根据超声心动图检查结果分为CAL组(10例)与无CAL组(51例);同时选取同期发热3~5 d的肺炎住院患儿为对照组(50例)。分别采用酶联免疫吸附法(ELISA)、电化学发光法、免疫比浊法,检测各组治疗前后血清细胞因子谱、PCT、血浆D-D的浓度水平,同时对相关因素行Logistic回归分析。结果 (1)川崎病CAL组治疗前血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-l0)、肿瘤坏死因子-α(TNF-α)、PCT及血浆D-D的浓度水平均显著高于无CAL组及对照组,均差异有统计学意义(P<0.05);(2)川崎病无CAL组治疗前各检测指标浓度水平均大于对照组,差异有统计学意义(P<0.05);(3)川崎病CAL组和无CAL组治疗前后IL-6、IL-8、TNF-α、PCT、D-D的浓度水平均差异有统计学意义(P<0.05);(4)无CAL组IL-10治疗前(25.43±1.43)ng·L-1与治疗后(21.13±1.29)ng·L-1比较,差异无统计学意义(t=1.59,P=0.115);(5)Logistic回归分析显示,IL-10、TNF-α、D-D是川崎病合并冠脉损伤的危险因素。结论早期检测且动态追踪血清IL-6、IL-8、IL-10、TNF-α、PCT、血浆D-D的浓度水平,可在病程早期辅助诊断川崎病并预测川崎病合并冠状动脉损害,从而为临床及时治疗、减少冠脉损伤提供科学依据。

Objective To investigate the clinical significance of cytokine profiles procalcitonin（PCT） and plasma D-dimer（D-D）levels in children with Kawasaki disease to explore its correlation with coronary artery injury（CAL） in Kawasaki disease. Methods61 children with Kawasaki disease were enrolled. According to the results of echocardiography they were divided into CAL group（10 cases） and non-coronary artery injury（non-CAL） group（51 cases）; children with pneumonia who had a fever for 3-5 days in the same period were selected as the control group（50 cases）. The levels of serum interleukin-6（IL-6）,IL-8,IL-10,tumor necrosis factor-α（TNF-α）,PCT and plasma D-D before and after treatment were detected by enzyme-linked immunosorbent assay（ELISA）,electrochemiluminescence and immunoturbidimetry. Logistic regression analysis was used to analyze the related factors. Results（1） The levels of serum IL-6,IL-8,IL-10,TNF-α,PCT and plasma D-D in CAL pre-treatment group were significantly higher than those in non-CAL pretreatment group and pneumonia control group,comparative differences were statistically significant（P〈0. 05）.（2） The levels of all test indexes in non-CAL pretreatment group were higher than those in the pneumonia control group,and the difference was statistically significant（P〈0. 05）.（3） The levels of serum IL-6,IL-8,TNF-α,PCT and plasma D-D in children with Kawasaki disease in pre-treatment and post-treatment were significantly different（P〈0. 05）.（4） The levels of IL-10 in the non-CAL pretreatment group were（25. 43 ± 1. 43） ng·L^-1,higher than the non-CAL post-treatment group（21. 13 ± 1. 29） ng·L^-1,but the difference was not statistically significant（t = 1. 59,P = 0. 115〉 0. 05）.（5） Logistic regression analysis showed that IL-10,TNF-α,D-D was a risk factor for Kawasaki disease complicated with coronary artery lesions. Conclusion Early detection and dynamic tracking of serum IL-6,IL-8,IL-10,TNF-α,PCT and plasma D-D levels can diagnose Kawasaki disease as an auxiliary methods in the early course of the disease and predict Kawasaki disease with coronary artery damage,so as to provide a scientific basis for clinical treatment and reduce coronary lesions.