可溶性细胞毒性T细胞相关抗原-4在川崎病中的表达及意义

The expression and significance of soluble cytotoxic T-lymphocyte-associated antigen-4 in Kawasaki disease

目的:研究川崎病(KD)患儿血浆可溶性细胞毒性T细胞相关抗原-4(sCTLA-4)的表达及其与冠状动脉损害的相关性。方法:KD患儿40例,按病程分为急性期组(KDA组)40例和亚急性期组(KDS组)22例;KDA组按有无冠状动脉损害分为冠状动脉损害组(CAL组)11例和非冠状动脉损害组(NCAL组)29例;KDA组按治疗效果分为静脉注射用免疫球蛋白(IVIG)敏感组33例及IVIG不敏感组7例。呼吸道感染所致发热患儿18例作为发热对照组(F组)。同期健康体检儿童及斜疝、隐睾择期手术患儿18例为对照组(C组)。记录相关临床资料、临床实验室检验结果,采用酶联免疫吸附试验(ELISA)检测血浆sCTLA-4浓度。结果:(1)KDA组血浆sCTLA-4水平6.50(3.44)ng/mL,分别高于KDS组4.44(3.71)ng/mL、F组5.19(2.30)ng/mL及C组2.76(2.13)ng/mL,差异均具有统计学意义(H=34.231,P<0.05)。(2)CAL组血浆sCTLA-4水平9.04(3.70)ng/mL,高于NCAL组5.99(1.75)ng/mL,差异有统计学意义(Z=2.881,P<0.01)。(3)IVIG敏感组与不敏感组血浆sCTLA-4水平的差异无统计学意义(Z=0.445,P>0.05)。(4)血浆sCTLA-4与CAL呈正相关(r=0.461,P<0.01)。(5)受试者工作特征曲线(ROC曲线)分析显示,sCTLA-4预测KD冠脉损害的曲线下面积(AUC)为0.798(P<0.05),取临界值6.75 ng/mL,其预测KD冠脉损害的灵敏度为0.909,特异度为0.759。结论:在KD急性期血浆sCTLA-4水平升高,存在冠脉损害患儿sCTLA-4水平高于无冠脉损害患儿,提示sCTLA-4可能参与KD以及KD冠脉损害的发生发展。

Objective:To study the expression of plasma soluble cytotoxic T-lymphocyte-associated antigen-4(sCTLA-4)in children with Kawasaki disease(KD)and the correlation between the expression of sCTLA-4 and coronary artery lesion.Methods:40 children with KD were divided into 40 cases in the acute phase group(KD_(A)group)and 22 cases in the subacute phase group(KDS group)according to the course of disease.The KD_(A)group was divided into 11 cases of coronary artery lesion group(CAL group)and 29 cases of non-coronary artery lesion group(NCAL group)according to the presence or absence of coronary artery lesion;The KD_(A)group was divided into 33 cases of intravenous immunoglobulin(IVIG)sensitive group and 7 cases of IVIG insensitive group according to the treatment effect.18 children with fever caused by respiratory tract infections served as a fever control group(group F).In the same period,18 healthy children and children undergoing elective surgery for indirect hernia and cryptorchidism were the control group(group C).Record relevant clinical data and clinical laboratory test results,and use enzyme-linked immunosorbent assay(ELISA)to detect plasma sCTLA-4 concentration.Results:(1)The sCTLA-4 level in group KD_(A)was 6.50(3.44)ng/mL,which was higher than that in group KD_(S)4.44(3.71)ng/mL,group F 5.19(2.30)ng/mL and group C 2.76(2.13)ng/mL,and the differences were statistically significant(H=34.231,P<0.05).(2)The sCTLA-4 level in CAL group was 9.04(3.70)ng/mL higher than that in NCAL group was 5.99(1.75)ng/mL,and the difference was statistically significant(Z=2.881,P<0.01).(3)There was no significant difference in plasma sCTLA-4 level between the IVIG sensitive group and the insensitive group(Z=0.445,P>0.05).(4)sCTLA-4 was positively correlated with CAL(r=0.461,P<0.01).(5)The receiver operator characteristic curve(ROC curve)of sCTLA-4 level predicting KD coronary artery lesion showed that the area under curve(AUC)was 0.798(P<0.05),and the critical value used to predict KD was 6.75 ng/mL,which had a sensitivity of 0.909 and a specificity of 0.759.Conclusions:In the acute phase of KD,plasma sCTLA-4 levels increase,and children with coronary artery lesion have higher levels of sCTLA-4 than children without coronary artery lesion,suggesting that sCTLA-4 may be involved in the development of KD and KD coronary artery lesion.