千金五石汤联合英夫利昔单抗治疗川崎病伴冠状动脉受损的效果及对患儿血清sTNFRⅡ/Ⅰ、Cav-1的影响

Effect of Qianjin Wushi Decoction combined with infliximab in the treatment of Kawasaki disease with coronary artery damage and its influence on serum sTNFRⅡ/Ⅰand Cav-1 in the patients

目的探究千金五石汤联合英夫利昔单抗治疗川崎病伴冠状动脉受损的效果及对患儿血清可溶性肿瘤坏死因子受体(s TNFR)Ⅱ/Ⅰ比值、陷窝蛋白-1(Cav-1)的影响。方法选取2023年5月至2024年2月河南省第二人民医院收治的112例KD伴冠状动脉受损患儿作为研究对象,采用随机数表法分为观察组和对照组各56例。对照组患儿采用英夫利昔单抗治疗,观察组患儿采用千金五石汤联合英夫利昔单抗治疗,疗程12周。比较两组患儿的临床疗效,以及治疗前后的临床症状积分、血脂[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)]、s TNFRⅡ/Ⅰ、Cav-1、外周血NOD样受体-3(NLRP3)炎症小体主要成分NLRP3、半胱天冬酶-1(Caspase-1)、凋亡相关斑点样蛋白(ASC)m RNA表达量和冠脉扩张情况,同时比较两组患儿的不良反应发生情况。结果观察组患儿的治疗总有效率为94.64%,明显高于对照组的78.57%,差异有统计学意义(P<0.05);治疗12周后,观察组患儿的眼结膜充血、发热、皮疹、口腔黏膜变化、淋巴结肿大评分分别为(0.36±0.11)分、(0.28±0.09)分、(0.30±0.08)分、(0.29±0.13)分、(0.37±0.12)分,明显低于对照组的(0.89±0.17)分、(0.74±0.13)分、(0.67±0.10)分、(0.75±0.16)分、(0.98±0.20)分,差异均有统计学意义(P<0.05);治疗12周后,观察组患儿的LDL-C、TG分别为(2.09±0.30)mmol/L、(0.82±0.21)mmol/L,明显低于对照组的(2.26±0.29)mmol/L、(1.03±0.36)mmol/L,HDL-C、TC分别为(1.38±0.32)mmol/L、(4.06±0.48)mmol/L,明显高于对照组的(1.14±0.29)mmol/L、(3.75±0.51)mmol/L,差异均有统计学意义(P<0.05);治疗12周后,观察组患儿的血清Cav-1、sTNFRⅡ/Ⅰ比值分别为(32.28±4.24)ng/mL、2.62±0.54,明显低于对照组的(41.39±6.45)ng/mL、3.75±0.86,差异均有统计学意义(P<0.05);治疗12周后,观察组患儿的NLRP3、Caspase-1、ASC m RNA表达量分别为0.30±0.07、0.43±0.11、0.25±0.06,明显低于对照组的0.57±0.11、0.72±0.15、0.47±0.14,差异均有统计学意义(P<0.05);治疗12周后,观察组冠脉扩张内径为(1.98±0.12)mm,明显低于对照组的(2.46±0.15)mm,差异有统计学意义(P<0.05);治疗期间,观察组患儿的不良反应发生率为8.93%,略高于对照组的7.14%,但差异无统计学意义(P>0.05)。结论千金五石汤联合英夫利昔单抗治疗可有效抑制KD伴冠状动脉受损患儿血清Cav-1、sTNFRⅡ/Ⅰ、NLRP3炎症小体表达,减轻冠脉损伤、调节脂代谢,疗效确切。

Objective To explore the effect of Qianjin Wushi Decoction combined with infliximab in the treatment of Kawasaki disease(KD)with coronary artery damage and its influence on the serum soluble tumor necrosis factor receptor(sTNFR)Ⅱ/Ⅰratio and caveolin-1(Cav-1)in the patients.Methods A total of 112 KD children with coronary artery damage admitted to the Second People's Hospital of Henan Province from May 2023 to February 2024 were selected and divided into an observation group and a control group by random number table method,with 56 cases in each group.The children in the control group were treated with infliximab,and those in the observation group were treated with Qianjin Wushi Decoction combined with infliximab,for 12 weeks.The clinical efficacy was compared between the two groups,as well as clinical symptom scores,blood lipids(total cholesterol[TC],low-density lipoprotein cholesterol[LDL-C],high-density lipoprotein cholesterol[HDL-C],triglycerides[TG]),sTNFRⅡ/Ⅰ,Cav-1,main component of peripheral blood NOD-like receptor-3(NLRP3)inflammasome(NLRP3),caspase-1,apoptosis-related spot-like protein(ASC)mRNA expression levels,and coronary artery dilation before and after treatment.Results The total effective rate of the observation group was 94.64%,which was significantly higher than 78.57%of the control group(P<0.05).After 12 weeks of treatment,the scores of ocular conjunctival congestion,fever,rash,oral mucosal changes,and lymph node enlargement in the observation group were(0.36±0.11)points,(0.28±0.09)points,(0.30±0.08)points,(0.29±0.13)points,and(0.37±0.12)points,respectively,significantly lower than(0.89±0.17)points,(0.74±0.13)points,(0.67±0.10)points,(0.75±0.16)points,(0.98±0.20)points in the control group(P<0.05).After 12 weeks of treatment,LDL-C and TG in the observation group were(2.09±0.30)mmol/L and(0.82±0.21)mmol/L,respectively,which were significantly lower than(2.26±0.29)mmol/L and(1.03±0.36)mmol/L in the control group,respectively;HDL-C and TC were(1.38±0.32)mmol/L and(4.06±0.48)mmol/L,respectively,which were significantly higher than(1.14±0.29)mmol/L and(3.75±0.51)mmol/L in the control group;the differences were statistically significant(P<0.05).After 12 weeks of treatment,the ratios of serum Cav-1 and sTNFRⅡ/Ⅰin the observation group were(32.28±4.24)ng/mL and 2.62±0.54,respectively,which were significantly lower than(41.39±6.45)ng/mL and 3.75±0.86 in the control group(P<0.05).After 12 weeks of treatment,the mRNA expression levels of NLRP3,Caspase-1,and ASC in the observation group were 0.30±0.07,0.43±0.11,and 0.25±0.06,respectively,significantly lower than 0.57±0.11,0.72±0.15,and 0.47±0.14 in the control group(P<0.05).After 12 weeks of treatment,the coronary artery dilation diameter in the observation group was(1.98±0.12)mm,which was significantly lower than(2.46±0.15)mm in the control group(P<0.05).During the treatment period,the incidence of adverse reactions was 8.93%in the observation group versus 7.14%in the control group,with no statistically significant difference(P>0.05).Conclusion Qianjin Wushi Decoction combined with infliximab can effectively inhibit the expression of serum Cav-1,sTNFRⅡ/Ⅰ,and NLRP3 inflammasome in KD children with coronary artery damage,reduce coronary artery damage,and regulate lipid metabolism,with accurate therapeutic effect.