免疫特征在幼年特发性关节炎和川崎病患儿鉴别诊断中的意义  

The immune indicators for differential diagnosis of juvenile idiopathic arthritis and Kawasaki disease

作　　者：杨冬节 岳玉林[1] 李松涛 周晋 YANG Dong-jie;YUE Yu-lin;LI Song-tao;ZHOU Jin(Department of Clinical Laboratory,Children's Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院检验科,南京210008

出　　处：《现代免疫学》2021年第4期284-288,296,共6页Current Immunology

基　　金：南京医科大学科研基金面上项目(2017NJMU069)。

摘　　要：为评价免疫学检测指标在幼年特发性关节炎(juvenile idiopathic arthritis,JIA)和川崎病(Kawasaki disease,KD)患儿鉴别诊断中的意义,选择JIA患儿68例、KD患儿113例作为研究对象,另选择68例健康儿童作为对照组。分别检测患儿治疗前及对照组儿童细胞免疫(CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、CD16^(+)CD56^(+)NK细胞、CD19^(+)B细胞、CD4^(+)/CD8^(+)比值)水平、体液免疫(IgG、IgM、C3、C4)水平、炎性因子(IL-10、IL-6、TNF-α和sIL-2R)水平,同时检测各组外周血白细胞(white blood cell,WBC)、血红蛋白(hemoglobin,Hb)、血小板(platelet,PLT)、CRP水平。结果显示,JIA组和KD组WBC计数、CRP水平明显高于对照组(P<0.05);JIA组和KD组C3、C4、IgG水平显著高于对照组(P<0.05),其中KD组水平最高;KD组CD8^(+)T细胞水平低于对照组(P<0.05),CD19^(+)B细胞水平明显高于对照组及JIA组(P<0.05),JIA组和KD组CD16^(+)CD56^(+)NK细胞水平均低于对照组(P<0.05);JIA组和KD组所有炎性因子指标均高于对照组(P<0.05);多因素Logistic回归分析和ROC曲线结果显示,鉴别诊断JIA和KD最有效的单项免疫学指标是C3,其AUC为0.850,多指标联合鉴别诊断JIA和KD的AUC为0.954。该研究提示,联合多项免疫学指标检测可以为临床早期鉴别诊断JIA和KD提供参考依据。To evaluate the significance of immunological indicators in the differential diagnosis of juvenile idiopathic arthritis(JIA)and Kawasaki disease(KD),68inpatients with JIA and 113inpatients with KD were collected as research subjects,and another 68healthy children were collected as healthy controls.The cellular immunity indicators(CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,CD16^(+)CD56^(+)NK cells,CD19^(+)B cells and ratio of CD4^(+)/CD8^(+))and humoral immunity indicators(IgG,IgM,C3and C4)as well as inflammatory factors(IL-10,IL-6,TNF-αand sIL-2R)were measured in patients before treatment and in healthy child controls,and the levels of white blood cells(WBC),hemoglobin(Hb),platelets(PLT)and CRP of each patient group were measured as well.The results showed that the levels of WBC and CRP in the JIA group and the KD group were significantly higher than those in the control group(P<0.05).The levels of C3,C4and IgG in the JIA group and the KD group were significantly higher than those in the control group(P<0.05),with the levels in the KD group were the highest;the level of CD8^(+)T cell in the KD group was lower than that in the control group(P<0.05),while the level of CD19^(+)B cell in the KD group was significantly higher than that in the control and the JIA group(P<0.05),the levels of NK cell in the JIA group and the KD group were lower than those in the control group(P<0.05);All inflammatory factors in the JIA group and the KD group were higher than those in the control group(P<0.05);multivariate Logistic regression analysis and ROC curve results showed that the most effective single immunological index for the differential diagnosis of JIA and KD was C3(AUC was 0.850),and the AUC of the multi-index combined for differential diagnosis of JIA and KD was 0.954.In conclusion,the combination of multiple immunological indicators could provide a reference for the early differential diagnosis of JIA and KD.

关 键 词：幼年特发性关节炎 川崎病 体液免疫 细胞免疫 炎性因子 

分 类 号：R725.9[医药卫生—儿科]