川崎病心肌和冠状动脉损伤与血清TNF-α和IL-6水平的研究  

The study on serum TNF-α,IL-6 levels and its role in myocardial injury,coronary artery lesions in children with Kawasaki disease

作　　者：汪芸[1] 崔小岱[1] 伏瑾[1] 孙春荣[1] 任军[1] 赵地[1] 马官福[1] 杜仲东[2] 李尔珍[1] 

机构地区：[1]首都儿科研究所附属儿童医院儿科,北京100020 [2]首都医科大学附属北京儿童医院

出　　处：《北京医学》2011年第5期395-398,共4页Beijing Medical Journal

基　　金：首都医学发展基金(2002-1018)

摘　　要：目的探讨川崎病(KD)患儿血清TNF-α、IL-6变化与心肌酶、肌钙蛋白-I(cTn-I)、冠状动脉损伤(CALs)及心功能间的关系。方法对23例KD患儿、11例急性上呼吸道感染患儿和10例健康儿童进行血清TNF-α、IL-6、心肌酶及cTn-I检测,超声心动图检查冠状动脉及心功能情况,分析其差异。结果①KD组急性期患儿TNF-α(88.27±64.16)pg/ml、IL-6(104.65±58.96)ng/ml,明显高于健康对照组的(6.96±4.37)pg/ml、(5.59±1.17)ng/ml和急性上呼吸道感染组的(20.42±13.05)pg/ml、(15.39±10.48)ng/ml(P均<0.01)。②CALs患儿TNF-α、IL-6分别为(113.29±62.52)pg/ml、(150.05±44.14)ng/ml,高于无CALs组患儿的(72.61±65.58)pg/ml、(96.29±61.81)ng/ml,(P<0.05和P<0.01),2例冠脉持续扩张患儿TNF-α、IL-6水平在恢复期仍维持较高水平;CALs组与无CALs组在CK-MB、左心室射血分数(LVEF)、左心室短轴缩短分数(LVFS)比较均无显著性差异(P均>0.1)。③KD组的CK-MB异常率为17.39,高于健康对照组和急性上呼吸道感染组,有显著性差异(P<0.05)。④急性期KD组TNF-α与CK-MB、cTN-I相关系数为0.326(P>0.1)和0.574(P<0.05)。结论 TNF-α、IL-6参与了KD的疾病过程,在冠状动脉损伤中发挥作用,对高TNF-α、IL-6水平的患儿应注意有无CALs存在;TNF-α高水平与KD患儿心肌炎症性损害相关,TNF-α水平明显升高对早期预测心肌和冠状动脉病变有意义。Objective To study the changes of serum TNF-αand IL-6 levels in Kawasaki disease（KD） and evaluate the relationships of them with myocardial injury and coronary artery lesions（CALs）.Methods Twenty-six patients suffering from KD,11 patients with acute fever and 10 healthy children were recruited in this study.The age of KD patients ranged from 8 months to 6.10 years.The diagnosis was based on the criteria revised in 1984 by the KD Research Committee in Japan.KD patients were divided into CALs group and non-CALs group.The levels of serum TNF-α,IL-6,myocardium enzymology and cardiac troponin I（cTn-I） in KD patients were compared with healthy children and acute fever patients respectively,then compared between CALs group and non-CALs group.Doppler echocardiography were performed to evaluate coronary artery and cardiac function.Results ①Serum TNF-α and IL-6 concentrations of acute KD patients were（52.39±36.99）pg/ml and（68.64±42.33）ng/ml,significantly higher than those with acute fever patients and healthy children（P 0.01）.②Serum concentrations of TNF-α and IL-6 in KD patients with CALs were（113.29±62.52）pg/ml and（150.05±44.14）ng/ml,non-CALs patients were（79.44±64.19）pg/ml and（99.49±59.20）ng/ml,CALs were higher than those with non-CALs,there was a significant statistical difference between them（P 0.05）.The elevation of TNF-α and IL-6 levels had continually existed in two convalescent patients who were detected with coronary artery dilatation by ultrasound.CK-MB,left ventricular ejection fraction（LVEF） and fraction shortening（FS） were statistically significant different between CALs group and non-CALs group.③CK-MB positive percentage in KD patients was 19.2%,it significantly higher than acute fever patient and healthy children（P 0.05）.④The levels of serum TNF-α were positively correlated with the levels of serum cTn-I（r = 0.675,P 0.05）.Conclusions The levels of serum TNF-α and IL-6 are markedly elevated in all patients with KD,especially evi

关 键 词：川崎病 肿瘤坏死因子-Α 白介素6 心肌损害 冠状动脉损伤 

分 类 号：R725.4[医药卫生—儿科]