全身型幼年特发性关节炎患儿血浆细胞因子测定及其临床意义

Detection and clinical significance of plasma cytokines in systemic juvenile idiopathic arthritis

目的明确不同细胞因子在全身型幼年特发性关节炎(systemic juvenile idiopathic arthritis,SJIA)中的变化及其对早期诊断的预警作用。方法采用回顾性研究,选取2019年11月至2023年1月在苏州大学附属儿童医院肾脏免疫科因发热伴CRP、红细胞沉降率(ESR)、铁蛋白升高就诊的患儿,比较SJIA与其他自身免疫性疾病患儿CRP、ESR、铁蛋白及34项血浆细胞因子水平的差异;回归分析细胞因子风险;并分析细胞因子与淋巴细胞亚群及疾病活动性之间是否相关。结果研究期间符合条件有发热伴CRP、ESR、铁蛋白升高的患儿118例,诊断SJIA的患儿20例,其他自身免疫性疾病患儿98例,SJIA患儿与其他自身免疫性疾病患儿相比CRP、ESR差异无统计学意义(Z值分别为0.721、0.345,均P>0.05);SJIA患儿铁蛋白、IL-27、IL-17A、IL-31、IFN-γ、IL-18与其他自身免疫性疾病患儿相比差异均具有统计学意义(Z值分别为2.628、-2.052、-2.763、-2.135、4.067、4.419,均P<0.05);单因素Logistic回归分析示IL-18(OR=1.003,95%CI:1.002~1.004,P<0.001)、IFN-γ(OR=1.004,95%CI:1.001~1.007,P=0.004)、IL-27(OR=0.846,95%CI:0.716~0.999,P=0.049)、IL-31(OR=0.657,95%CI:0.451~0.959,P=0.028)与SJIA的发生密切相关;逐步Logistic回归分析提示IL-18升高(OR=1.005,95%CI:1.003~1.009,P=0.004)会增加SJIA风险,IL-5升高(OR=0.619,95%CI:0.402~0.953,P=0.029)会降低其风险;IL-18(r=0.673,P=0.020)、IL-27(r=0.486,P=0.041)、TNF-α(r=0.560,P=0.016)与SJIA的活动性呈正相关。结论IL-18是与SJIA发生风险呈正相关的特征性细胞因子,而IL-5则作为SJIA的保护性细胞因子,两者均具有独立预测风险的能力。

Objective To investigate the changes of different cytokines in systemic juvenile idiopathic arthritis(SJIA)and their role in early diagnosis.Methods A retrospective study was conducted to select pediatric patients with fever accompanied by elevated levels of CRP,erythrocyte sedimentation rate(ESR),and ferritin who visited the Department of Renal Immunology,Children's Hospital of Soochow University from November 2019 to January 2023.Compare the differences in CRP,ESR,ferritin,and 34 plasma cytokines levels between children with SJIA and other autoimmune diseases.Cytokine risk was analyzed by regression;Correlation analysis was performed to determine whether cytokines were associated with lymphocyte subsets and disease activity.Results During the study period,118 children with fever accompanied by elevated CRP,ESR and ferritin were eligible,among whom 20 children with SJIA were diagnosed,and 98 children with other autoimmune diseases were diagnosed.There was no statistically significant difference in CRP and ESR between SJIA patients and children with other autoimmune diseases(Z values were 0.721 and 0.345,all P>0.05);There were significant differences in ferritin,IL-27,IL-17A,IL-31,IFN-,IL-18 between children with SJIA and those with other autoimmune diseases(Z values were 2.628,-2.052,-2.763,-2.135,4.067,4.419,all P<0.05).Univariate Logistic regression analysis showed that IL-18(OR=1.003,95%CI:1.002~1.004,P<0.001),IFN-(OR=1.004,95%CI:1.001~1.007,P=0.004),IL-27(OR=0.846,95%CI:0.716~0.999,P=0.049),IL-31(OR=0.657,95%CI:0.451~0.959,P=0.028)were closely related to the occurrence of SJIA,and stepwise Logistic regression analysis indicated that the increase of IL-18(OR=1.005,95%CI:1.003~1.009,P=0.004) increased the risk of SJIA,and the increase of IL-5(OR=0.619,95%CI:0.402~0.953,P=0.029)decreased the risk.IL-18(r=0.673,P=0.020),IL-27(r=0.486,P=0.041)and TNF-α(r=0.560,P=0.016)were positively correlated with the activity of SJIA.Conclusion IL-18 presents a characteristic cytokine positively correlated with the risk of SJIA,while IL-5 presents a protective cytokine against SJIA.Both cytokines have independent predictive powerfor the risk.