微血管炎症及心肌纤维化指标在早期川崎病诊断中的临床意义

Clinical significance of microvascular inflammation and myocardial fibrosis in early diagnosis of kawasaki disease

目的探讨微血管炎症及心肌纤维化指标[金属蛋白酶1组织抑制剂(TIMP-1)、半乳糖凝集素-3(Gal-3)、转化生长因子-β(TGF-β)、脂质运载蛋白2(Lcn2)]在川崎病(KD)诊断中的意义。方法选取2020年1月-2022年1月唐山市妇幼保健院KD患儿100例,分别在KD急性期与亚急性期抽取所有患儿血液样本测定相关生化指标(TIMP-1、Gal-3、TGF-β、Lcn2)水平,超声检测冠状动脉内径D值、心肌灌注状态。统计KD患儿不同时期、不同冠状动脉内径、不同心肌灌注情况者相关生化指标(TIMP-1、Gal-3、TGF-β、Lcn2)水平。结果KD急性期患者TIMP-1、Gal-3、TGF-β、Lcn2水平高于亚急性期,差异有统计学意义(P<0.05);100例KD患儿中,冠状动脉内径异常者36例(CAL组)、无冠状动脉内径异常者64例(NCAL组),CAL组TIMP-1水平低于NCAL组,Gal-3、TGF-β、Lcn2水平高于NCAL组,差异有统计学意义(P<0.05);本组100例KD患儿中,心肌灌注异常者38例(异常组)、心肌灌注正常者62例(正常组),异常组患者TIMP-1水平低于正常组,Gal-3、TGF-β、Lcn2水平高于正常组,差异有统计学意义(P<0.05)。结论KD患儿存在微血管炎症及心肌纤维化,TIMP-1、Gal-3、TGF-β、Lcn2水平均有所异常,且异常程度与疾病所处时期、心肌损伤等存在密切关联性,可通过测定其水平对疾病进行诊断评估。

Objective To explore the markers of microvascular inflammation and myocardial fibrosis[tissue inhibitor of metalloproteinase-1(TIMP-1),galectin-3(Gal-3),transforming growth factor-β(TGF-β),lipid transporter 2(Lcn2)]in the diagnosis of Kawasaki disease(KD).Methods From January 2020to January 2022,100cases of KD children in Tangshan Maternal and Child Health Hospital were selected,and the blood samples were taken all the children in the acute and subacute stages of KD to determine the relevant biochemical indicators(TIMP-1,Gal-3,TGF-β,Lcn2)levels,the coronary artery diameter D value and myocardial perfusion status were detected by ultrasound.The biochemical indicators(TIMP-1,Gal-3,TGF)related to KD children in different periods,different coronary artery diameters,and different myocardial perfusion horizontality were analyzyed.Results The levels of TIMP-1,Gal-3,TGF-β,Lcn2in KD acute phase were higher than those in subacute stage(P<0.05).Among 100KD children,36patients had abnormal coronary artery diameter(divided into CAL group)and 64didn’t have abnormal coronary artery diameter(divided into NCAL group).The level of TIMP-1in CAL group was lower than that in NCAI group(P<0.05),The levels of Gal-3,TGF-β,Lcn2were significantly higher than those in NCAI group(P<0.05).Among 100KD children group,38patients had abnormal myocardial perfusion(divided into abnormal group)and 62patients had normal myocardial perfusion(divided into normal group),the level of TIMP-1of the patients in abnormal group was lower than that in normal group,the levels of Gal-3,TGF-β,Lcn2were significantly higher than those in normal group(P<0.05).Conclusion KD children have microvascular inflammation and myocardial fibrosis,the level of TIMP-1,Gal-3,TGF-β,Lcn2are abnormal,and the degree of abnormality is closely related to the period of the disease and myocardial injury.The disease can be diagnosed and evaluated by measuring its level.