川崎病合并冠状动脉病变患儿血清SDC-1、ANXA1与炎性反应、凝血功能和内皮功能的关系及危险因素

Relationship between serum levels of polyligand proteoglycan 1,annexin A1 and inflammatory response,coagulation function and endothelial function in children with Kawasaki disease complicated by coronary artery disease

目的分析川崎病合并冠状动脉病变(CALs)患儿血清多配体蛋白聚糖-1(SDC-1)、膜联蛋白A1(ANXA1)水平与炎性反应、凝血功能和内皮功能指标的关系,以及川崎病患儿发生CALs的危险因素。方法选取2016年3月—2020年9月辽宁省本溪市中心医院儿科收治川崎病患儿82例(川崎病组),其中合并CALs 24例(合并CALs亚组),未合并CALs 58例(无CALs亚组);另选择健康儿童63例为健康对照组。检测各组血清SDC-1、ANXA1、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、内皮素-1(ET-1)、细胞间黏附分子(ICAM-1)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)及血浆纤维蛋白原(FIB)水平。分析血清SDC-1、ANXA1与炎性反应、凝血功能、内皮功能指标及CALs的关系。Logistic回归分析川崎病患儿发生CALs的危险因素。结果川崎病组血清ANXA1水平、TT、APTT明显低于健康对照组(t/P=16.377/0.000、5.519/0.000、13.252/0.000),血清SDC-1、TNF-α、IL-6、ET-1、ICAM-1及血浆FIB水平高于健康对照组(t/P=13.318/0.000、16.679/0.000、25.641/0.000、9.386/0.000、75.893/0.000、16.879/0.000);合并CALs亚组血清ANXA1水平及TT、APTT低于无CALs亚组(t/P=28.450/0.000、10.686/0.000、5.302/0.000),血清SDC-1、TNF-α、IL-6、ET-1、ICAM-1及血浆FIB水平高于无CALs亚组(t/P=10.856/0.000、39.316/0.000、6.901/0.000、6.399/0.000、5.811/0.000、15.489/0.000)。Pearson相关分析结果显示,川崎病组血清SDC-1水平与TNF-α、IL-6、ET-1、ICAM-1水平呈正相关(r/P=0.675/0.000、0.702/0.000、0.611/0.000、0.532/0.000),血清ANXA1水平与TNF-α、IL-6、ET-1、ICAM-1及FIB水平呈负相关(r/P=-0.635/0.000、-0.698/0.000、-0.584/0.000、-0.503/0.002、-0.431/0.009),与TT、APTT呈正相关(r/P=0.356/0.015、0.302/0.019)。Logistic逐步回归分析结果显示,高水平SDC-1、IL-6、FIB,低水平ANXA1是川崎病患儿发生CALs的危险因素[OR(95%CI)=1.933(1.865~2.096)、1.881(1.724~1.937)、2.003(1.945~2.235)、0.825(0.705~0.964)]。结论川崎病合并CALs患者血清SDC-1水平升高,ANXA1水平降低,高水平SDC-1和低ANXA1可加重川崎病冠状动脉病变进程。

Objective To analyze the relationship between serum polyglycan 1(SDC-1)and annexin A1(ANXA1)levels in children with Kawasaki disease complicated with coronary artery disease(CALs)and inflammatory response,coagulation function and endothelial function indicators,as well as Kawasaki disease influencing factors of CALs in children.Methods From March 2016 to September 2020,82 children with Kawasaki disease(Kawasaki disease group)were admitted to the Department of Pediatrics of Benxi Central Hospital,Liaoning Province,24 cases with CALs(combined CALs subgroup),and 58 cases without CALs(no CALs subgroup)In addition,63 healthy children were selected as the healthy control group.Detection of serum SDC-1,ANXA1,tumor necrosis factorα(TNF-α),interleukin 6(IL-6),endothelin 1(ET-1),intercellular adhesion molecule(ICAM-1),thrombin time(TT),activated partial prothrombin in each group Time(APTT),fibrinogen(FIB)level.Analyze the relationship between serum SDC-1,ANXA1 and inflammatory response,coagulation function,endothelial function indexes and CALs.Logistic analysis of risk factors for CALs in children with Kawasaki disease.Results The serum levels of ANXA1,TT and APTT in the Kawasaki disease group were significantly lower than those in the healthy control group(t/P=16.377/0.000,5.519/0.000,13.252/0.000),and the serum levels of SDC-1,TNF-α,IL-6,ET-1,ICAM-1 and FIB were higher than those of healthy controls Control group(t/P=13.318/0.000,16.679/0.000,25.641/0.000,9.386/0.000,75.893/0.000,16.879/0.000);the combined CALs subgroup serum ANXA1 level,TT,APTT are lower than the non-CALs subgroup(t/P=28.450/0.000,10.686/0.000,5.302/0.000),serum SDC-1,TNF-α,IL-6,ET-1,ICAM-1 and FIB levels were higher than the subgroup without CALs(t/P=10.856/0.000,39.316/0.000,6.901/0.000,6.399/0.000,5.811/0.000,15.489/0.000).The results of Pearson correlation analysis showed that serum SDC-1 levels in Kawasaki disease group were positively correlated with TNF-α,IL-6,ET-1,and ICAM-1 levels(r/P=0.675/0.000,0.702/0.000,0.611/0.000,0.532/0.000).Serum ANXA1 levels are negatively correlated with TNF-α,IL-6,ET-1,ICAM-1 and FIB levels(r/P=-0.635/0.000,-0.698/0.000,-0.584/0.000,-0.503/0.002,-0.431/0.009),and positively correlated with TT and APTT(r/P=0.356/0.015,0.302/0.019).Logistic stepwise regression analysis showed that high levels of SDC-1,IL-6,FIB,and low levels of ANXA1 were risk factors for CALs in children with Kawasaki disease[OR(95%CI)=1.933(1.865 to 2.096),1.881(1.724 to 1.937),2.003(1.945~2.235),0.825(0.705~0.964)].Conclusion The serum SDC-1 level of patients with Kawasaki disease combined with CALs is increased,and the level of ANXA1 is decreased.The lack of high levels of SDC-1 and low ANXA1 can aggravate the progression of coronary artery disease in Kawasaki disease.