丙种球蛋白无反应型川崎病患儿肿瘤坏死因子-α、可溶性肿瘤坏死因子受体-1检测的意义  

Study of tumor necrosis factor-α, soluble tumor necrosis factor receptor-1 levels and its role in intravenous immunoglobulin non-responsive children with Kawasaki disease

作　　者：汪芸[1] 石琳[1] 马官福[1] 赵地[1] 任军[1] 苏英姿[1] 孙春荣[1] 伏瑾[1] 崔晓岱[1] 

机构地区：[1]首都儿科研究所附属儿童医院儿科,100020

出　　处：《中华实用儿科临床杂志》2014年第21期1635-1639,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的观察川崎痫（KD）患儿大剂量静脉注射用丙种球蛋白（IVIG）的治疗效果，分析血清肿瘤坏死因子-α（TNF—α）、叮溶性肿瘤坏死因子受体-1（sTNFR1）的变化，为IVIG无反应型KD患儿的治疗提供依据。方法选择发病10d内接受IVIG标准治疗的KD患儿83例，比较IVIG无反应组与敏感组患儿间血清TNF-α、sTNFR1水平的差异。同时选取健康对照儿童33例，比较其与KD患儿间的差异。结果1.IVIG无反应组[45．4％（5／11例）]患儿出现冠状动脉损害（CALs）高于敏感组[33．3％（24／72例）]，差异有统计学意义（P〈0．05）。2．治疗前，11例IVIG无反应组KD患儿血清TNF—α水平[（190．7±125．4）ng／L]高于72例敏感组患儿[（104．2±95．5）ng／L]及健康对照儿童[（19．0±8．3）ng／L]，差异有统计学意义（P〈0．05）；治疗后，IVIG无反应组TNF—α水平[（68．8±49．5）ng／L]仍高于敏感组[（36．8±28．7）ng／L]，差异有统计学意义（P〈0．05）；再次IVIG后，IVIG无反应组血清TNF—α水平接近于健康对照组，差异无统计学意义（P〉0．05）。3．健康对照组儿童血清sTNFR1为（5．4±1．9）μg／L，IVIG无反应组和敏感组治疗前sTNFR1分别为（4．6±1．9）μg／L和（4．7±2．9）μg/L，两两比较差异均无统计学意义（P均〉0．05）。4．IVIG无反应组5例CALs患儿TNF—α水平[（266．8±117．3）ng／L]高于同组6例无CALs患儿[（126．2±93．7）ng／L]，亦高于敏感组24例CALs患儿[（118．8±96．1）ng／L]，两两比较差异均有统计学意义（P均〈0．05）。5．WIG无反应组患儿C反应蛋白、乳酸脱氢酶水平高于敏感组，血红蛋白、清蛋白水平低于敏感组，2组问差异有统计学意义（P均〈0．05）。结论KD患儿体内不仅存在TNF-α水平异常升高，还伴发sTNFR1水平异常，IVIG无反应组更明显；IVIG可使TNF-α水平降低，但在无反应组中需要更�Objective To investigate the outcome of intravenous immunoglobulin （IVIG） therapy in children with Kawasaki disease （ KD）, and to study serum tmnor necrosis factor- α（TNF-α） , soluble tumor necrosis factor receptor-1 （sTNFR1） levels in these patients,and to explore further treatment of IVIG non-responsive. Methods Eighty- three patients with KI） received initial IVIG and aspirin therapy within 10 days. Patients were divided into non-responsive group and sensitive group, while the clinical experiences and the outcome of them were recorded. Thirty-three health children were also recruited in this study, and the levels of serum TNF-α, sTNFR1 in KD patients were compared with health children and within different groups. Results 1. In non-responsive group, the rate of coronary artel3, lesions （CALs） was 45.4% （ 5/11 cases） in non-responsive group, but 33.3% （ 24/72 cases） in sensitive group, there was a statistical difference between them（ P 〈 0.05 ）. 2. Before therapy, serum TNF-α concentrations of non-responsive group were significantly higher than sensitive group [ （ 190.7 ± 125.4 ） ng/L vs （ 104.2 ± 95.5 ） ng,/L ], so there was a statistical difference between them（ P 〈0.05 ）. The elevation of TNF-α levels had continually existed in non-responsive group after initial 1VIG therapy[ （68.8 ±49.5） ng/L vs （36.8 ±28.7） ng/L] ,and there was also a statistical difference between non-responsive group and sensitive group （ P 〈 0.05 ）. Serum TNF-α concentrations of non-responsive KD patients decreased to （21.2 ± 7.4） ng/L after second IVIG,health children were （ 19.0 ± 8.3 ） ng,/L, so there was no statistical difference between them（P 〉0.05）. 3. Serum sTNFR1 concentration was （4.6 ± 1.9） μg/L in non-responsive group, （4.7 ± 2. g） μg/L in sensitive group, （5.4 ± 1.9 ） μg/L in health children, so there was no statistical difference between them（ P 〉 0.05 ）. 4. In non-responsive group, serum TNF-α contentrations o

关 键 词：川崎病 静脉注射用免疫球蛋白无反应 肿瘤坏死因子-Α 可溶性肿瘤坏死因子受体 冠状动脉 损害 

分 类 号：R725.4[医药卫生—儿科]