IVIG不敏感型川崎病循环内皮细胞、内皮细胞微粒检测的临床意义

The clinical significance of the detection of circulating endothelial cells and endothelial microparticles in Kawasaki disease patients with not sensitive intravenous immunoglobulin type

目的探讨静脉注射免疫球蛋白(Intravenous immunoglobulin,IVIG)不敏感型川崎病中循环内皮细胞(Circulating endothelial cells,CECs)、内皮细胞微粒(Endothelial microparticles,EMPs)检测的临床意义。方法选取小儿川崎病患者55例为研究对象,分别在急性期、亚急性期和恢复期检测外周静脉血中CECs、EMPs及IL-6、TNF-α的水平,同时在疾病各个时期行心脏彩超检查,动态监测冠状动脉病变(Coronary artery lesions,CALs)情况。根据研究对象对IVIG敏感程度,选取IVIG不敏感型川崎病9例为观察组,随机选取18例IVIG敏感型川崎病为对照组,其中观察组根据病程中出现CALs与否分为CALs组5例、NCALs组4例,总结临床资料并统计分析。结果(1)观察组急性期、亚急性期CECs、EMPs水平高于同期对照组,差异有统计学意义(P<0.05);恢复期观察组与对照组CECs、EMPs水平差异无统计学意义(P>0.05)。(2)观察组在亚急性期CECs、EMPs、IL-6、TNF-α水平略低于急性期,但差异无统计学意义(P>0.05);其急性期及亚急性期以上指标明显高于恢复期,差异有统计学意义(P<0.05)。(3)采用Spearman相关系数分析,观察组CECs与IL-6、TNF-α呈正相关(r=0.691,P<0.01;r=0.584,P<0.01);观察组EMPs与IL-6、TNF-α呈正相关(r=0.714,P<0.01;r=0.799,P<0.01)。(4)观察组中CALs组急性期及亚急性期CECs、EMPs、IL-6、TNF-α水平均高于同期NCALs组,差异有统计学意义(P<0.05);恢复期两组指标差异均无统计学意义(均P>0.05)。结论IVIG不敏感型川崎病患者CECs、EMPs水平变化与全身中小血管炎密切相关,考虑外周静脉血CECs、EMPs检测可能有助于对川崎病患者出现IVIG不敏感的早期预测,有助于对IVIG不敏感型川崎病患者疗效评估及出现冠状动脉病变的早期判断。

Objective To investigate the clinical significance of the detection of circulating endothelial cells(CECs)and endothelial microparticles(EMPs)in Kawasaki disease patients with not sensitive intravenous immunoglobulin(IVIG)type.Methods 55 children with Kawasaki disease from our department of our hospital were enrolled,and the levels of CECs,EMPs,IL-6,and TNF-αin the peripheral venous blood were checked,the coronary artery lesions(CALs)were observed with the heart color Doppler ultrasound in the acute phase,the subacute phase,and the recovery phase.According to IVIG sensitivity of the research objects,9 cases of Kawasaki disease patients with not sensitive IVIG type were selected as the observation group,and 18 cases of Kawasaki disease patients with sensitive IVIG type were selected as the control group.According to CALs appearing or not in the course of the disease,the observation group was subdivided into the CALs group(5 cases)and the NCALs group(4 cases).And the summary statistics analysis was carried out.Results(1)The levels of CECs and EMPs in the observation group were higher than those in the control group in the acute phase and the subacute phase,with statistically significant differences(P<0.05).There were no statistically significant differences in the levels of CECs,EMPs between the observation group and the control group in the recovery phase(P>0.05).(2)In the observation group,the levels of CECs,EMPs,IL-6,TNF-αin the subacute phase were slightly lower than those in the acute phase,but there were no statistically significant differences(P>0.05).The above indexes in the acute phase and the subacute phase were significantly higher than those in the recovery phase,with statistically significant differences(P<0.05).(3)The Spearman correlation coefficient analysis showed that,CECs was positively correlated with IL-6,TNF-αrespectively in the observation group(r=0.691,P<0.01;r=0.584,P<0.01),EMPs was positively correlated with IL-6,TNF-αrespectively(r=0.714,P<0.01;r=0.799,P<0.01).(4)In the observation group,the levels of CECs,EMPs,IL-6,TNF-αin the CALs group were higher than those in the NCALs group in the acute phase and the subacute phase,with statistically significant differences(P<0.05);there were no statistically significant differences in the above indexes between the two groups in the recovery phase(P>0.05).Conclusions The changes of the levels of CECs,EMPs in children with Kawasaki disease with not sensitive IVIG type are closely related to small and medium-sized vasculitis of the whole body,and we speculate that CECs,EMPs testing in the peripheral venous blood possibly help to early predict Kawasaki disease with not sensitive IVIG type,and help to evaluate the curative effect and judge the coronary artery lesions of Kawasaki disease with not sensitive IVIG type.