川崎病患儿血管内皮损伤的临床干预  

Clinical Intervention on Vascular Endothelial Injury in Children with Kawasaki Disease

作　　者：皮光环[1] 田小兵[2] 王媚[1] 吴春[1] 黄越[1] 孙群英[1] 何云[1] 

机构地区：[1]川北医学院附属医院儿科,四川南充637000 [2]川北医学院流行病学教研室,四川南充637000

出　　处：《实用儿科临床杂志》2009年第18期1431-1433,共3页Journal of Applied Clinical Pediatrics

基　　金：四川省卫生厅课题资助[川卫办发(2006)437号]

摘　　要：目的探讨川崎病患儿外周血循环内皮细胞(CEC)数量和外周血浆血管性假性血友病因子(vWF)水平与冠状动脉(冠脉)损害的关系,探讨静脉注射免疫球蛋白(IVIG)和低分子肝素钠治疗对其影响。方法川崎病45例,无冠脉损害组30例、冠脉损害组15例。健康儿童20例为健康对照组。所有川崎病患儿于病程的5～10 d单次输入IVIG治疗,2 g/kg,并均于IVIG治疗第4天开始予低分子肝素钠治疗,100 IU/kg,1次/12 h,皮下注射,连用7 d。采用免疫磁珠分离方法计数各组儿童外周血CEC,双抗体夹心酶联免疫吸附(ELISA)法检测其外周血浆vWF水平。结果外周血CEC数量:冠脉损害组高于无冠脉损害组,且2组均高于健康对照组(F=151.7 P<0.001);外周血浆vWF水平:冠脉损害组高于无冠脉损害组,且2组均高于健康对照组(F=16.2 P<0.001);川崎病急性期IVIG干预治疗前后冠脉损害组、无冠脉损害组CEC数量、vWF水平变化均有显著统计学差异(t=9.31,4.43Pa<0.001;t=8.92 P<0.001,t=2.97 P<0.01)。低分子肝素钠干预治疗前后CEC数量、vWF水平:冠脉损害组和无冠脉损害组均有显著差异(t=3.45 P<0.001,t=2.28 P<0.05;t=3.51 P<0.001,t=2.61 P<0.01)。结论川崎病存在明显的血管内皮损伤,有冠脉损害者血管内皮损伤更严重,IVIG和低分子肝素钠干预治疗对其有明显改善作用。Objective To investigate the relationship between coronary artery lesions and circulation endothelial cells （CEC） in peripheral blood and level of blood plasma von Willebrand factor （vWF） in Kawasaki disease （KD） patients, and influence of immunoglobulin intravenous （IVIG） and low molecular heparin treatment on them. Methods There were 45 children with KD in the study. According to with or without coronary artery lesions they were divided into 2 groups. The first group had 30 children without coronary artery lesions, the other had 15 children with coronary artery lesions. Twenty healthy children were served as healthy control group. All patients with KD were treated with IVIG, 2 g/kg in a single infusion on days 5 to 10 of illness and begun treatment of low molecular heparin in the first 4 days after IVIG therapy, 100 IU/kg, one time every 12 hours, hypodermic, continuous use for 7 days. CEC were isolated from peripheral blood with immunomagnetic Dynabeads and were counted by using microscopy. Level of blood plasma vWF was determined by double antibody sandwich enzyme linked immunosorbent assay. Results CEC count in peripheral blood in coronary artery lesions group was higher than that in without coronary artery lesions group,and higher in both groups than that in healthy control group （F = 151.7 P 〈 0. 001 ）. Level of blood plasma vWF in the coronary artery lesions group was higher than that in without coronary artery lesions group and higher in both groups than that in healthy control group（ F = 16. 2 P 〈 0. 001 ）. There were significant differences of CEC quantity and level of blood plasma vWF before and after IVIG treatment in coronary artery lesions group（ t = 9. 31,4.43 Pa 〈 0. 001 ） or without coronary artery lesions group （ t = 8. 92 P 〈 0. 001 ,t = 2.97 P 〈 0. 01 ） 1- There were significant differences also of CEC quantity and level of blood plasma vWF before and after low molecular heparin treatment in coronary artery lesions group （t = 3.45 P 〈 0. 001, t =

关 键 词：川崎病 静脉注射免疫球蛋白 低分子肝素钠 循环内皮细胞 血管性假性血友病因子 

分 类 号：R725.4[医药卫生—儿科]