血清TNF-α、IL-6、IFN-γ及CD3^(+)、CD4^(+)、CD8^(+)在川崎病合并流感病毒感染患儿中的检测价值

Detection value of serum TNF-α,IL-6,IFN-γ and CD3^(+),CD4^(+),CD8^(+) in children infected with influenza virus in Kawasaki disease

目的 探讨血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、γ-干扰素(IFN-γ)及CD3^(+)、CD4^(+)、CD8^(+)在川崎病合并流感病毒感染患儿中的检测价值。方法 选择2016年10月-2020年3月在哈励逊国际和平医院进行治疗的30例川崎病合并流感病毒感染患儿为川崎病合并流感组,100例未感染流感病毒患儿为单纯川崎病组,100例流感病毒患儿为单纯流感组,分析血清TNF-α、IL-6、IFN-γ及CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平变化情况,采用受试者工作特征(ROC)曲线分析血清TNF-α、IL-6、IFN-γ及CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)在川崎病合并流感病毒感染中的预测价值。结果 川崎病合并流感组血清TNF-α、IL-6、IFN-γ、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均显著高于单纯川崎病组、单纯流感组,单纯川崎病组血清TNF-α、IL-6、IFN-γ、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均显著高于单纯流感组,差异均有统计学意义(F=135.714、546.752、110.467、254.770、300.654、22.686、37.603,P均<0.05)。川崎病合并流感组患者冠脉损害比例、发热持续时间[46.67%、(11.35±4.31)d]均显著高于单纯川崎病组[19.00%、(6.25±2.13)d],差异均有统计学意义(t=9.326,χ^(2)=8.819;P均<0.05)。ROC结果显示,血清TNF-α、IL-6、IFN-γ、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)预测川崎病合并流感病毒感染的曲线下面积(AUC)分别为0.779、0.993、0.819、0.769、0.634、0.831、0.964,截断值分别为11.43μg/L、50.89μg/L、16.26μg/L、79.72%、38.74%、3.75%、4.48,差异均有统计学意义(P均<0.05)。结论 在川崎病合并流感病毒感染中血清TNF-α、IL-6、IFN-γ及T细胞免疫表达异常,对川崎病合并流感病毒感染的发生有一定的预测价值,临床应用价值高。

Objective To study the detection value of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interferon-γ(IFN-γ)and CD3^(+),CD4^(+),CD8^(+)in children infected with influenza virus in Kawasaki disease.Methods A total of 30 cases of Kawasaki disease with influenza virus infection treated in Harrison International Peace Hospital from October 2016 to March 2020 were selected as Kawasaki disease combined with influenza group,100 cases of uninfected influenza virus were selected as simple Kawasaki disease group,and 100 cases of influenza virus children were selected as simple influenza group.Serum levels of TNF-α,IL-6,IFN-γ and CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)were analyzed,and the predictive value of serum TNF-α,IL-6,IFN-γ and CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in Kawasaki disease combined with influenza virus infection was analyzed by receiver operating characteristic(ROC)curve.Results Serum levels of TNF-α,IL-6,IFN-γ,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in Kawasaki disease combined with influenza group were significantly higher than those in simple Kawasaki disease group and simple influenza group;Serum levels of TNF-α,IL-6,IFN-γ,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in simple Kawasaki disease group were significantly higher than those in simple influenza group,the differences were statistically significant(F=135.714,546.752,110.467,254.770,300.654,22.686,37.603;all P<0.05).The proportion of coronary artery damage and fever duration[46.67%,(11.35 ± 4.31)d] in Kawasaki disease combined with influenza group were significantly higher than that in simple Kawasaki disease group[19.00%,(6.25±2.13)d],and the differences were statistically significant(t=9.326,χ^(2)=8.819;both P<0.05).ROC results showed that the area under the curve(AUC)of serum TNF-α,IL-6,IFN-γ,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)for predicting Kawasaki disease combined with influenza virus infection were 0.779,0.993,0.819,0.769,0.634,0.831,0.964,respectively.The cut-off values were 11.43 μg/L,50.89 μg/L,16.26 μg/L,79.72%,38.74%,3.75% and 4.48,respectively,with statistical significance(all P<0.05).Conclusion The serum levels of TNF α,IL-6,IFN-γ and T cell immune expression were abnormal in Kawasaki disease combined with influenza virus infection,which had certain predictive value and clinical application value in the occurrence of Kawasaki disease combined with influenza virus infection.