Tfh、Tfr及N-末端脑钠肽前体在不完全川崎病诊治中的表达  

Expression of Tfh,Tfr and N-terminal pro-brain natriuretic peptide in the diagnosis and treatment of incomplete Kawasaki disease

作　　者：纪小琳 沈伟锋[1] 汤冬梅 施佳卿 JI Xiaolin;SHEN Weifeng;TANG Dongmei;SHI Jiaqing(Department of Clinical Laboratory,the First Affiliated Hospital of Jiaxing University,the First Hospital of Jiaxing,Zhejiang Jiaxing 314000,China;Department of Pediatrics,the First Affiliated Hospital of Jiaxing University,the First Hospital of Jiaxing,Zhejiang Jiaxing 314000,China)

机构地区：[1]嘉兴学院附属第一医院/嘉兴市第一医院检验科,浙江嘉兴314000 [2]嘉兴学院附属第一医院/嘉兴市第一医院儿科,浙江嘉兴314000

出　　处：《中国妇幼健康研究》2021年第11期1659-1665,共7页Chinese Journal of Woman and Child Health Research

摘　　要：目的分析滤泡辅助T细胞(Tfh)、滤泡调节性T细胞(Tfr)及N-末端脑钠肽前体(NT-proBNP)对不完全川崎病(IKD)的诊断作用及对丙种球蛋白联合阿司匹林治疗后的疗效预测作用。方法选取2014年1月至2019年12月于嘉兴市第一医院接受治疗的272例川崎病患儿为研究对象,按照诊断标准分为完全川崎病组(CKD组)和不完全川崎病组(IKD组),经丙种球蛋白联合阿司匹林治疗后分析各组临床效果、Tfh、Tfr及其他实验室生化指标变化。结果CKD组患儿治疗后总有效率为95.11%,IKD组总有效率为95.45%,差异无统计学意义(χ^(2)=0.016,P>0.05);IKD组临床症状消退时间(发热、黏膜充血、皮疹、手足肿胀、淋巴结肿大)短于CKD组,差异有统计学意义(t值分别为7.037、5.421、4.117、5.824、6.126,P<0.05);治疗前,CKD组冠状动脉损伤(CAL)发生率低于IKD组,差异有统计学意义(χ^(2)=25.936,P<0.05),治疗后CAL发生率组间差异无统计学意义(P>0.05);治疗后,IKD组伴CAL患儿NT-proBNP、Tfh细胞比率及Tfh/Tfr高于CKD组伴CAL患儿,Tfr比率低于CKD组伴CAL患儿,差异均有统计学意义(t值分别为11.336、5.891、18.613、4.221,P<0.05);治疗前Tfh比率、Tfh/Tfr及NT-proBNP对IKD具有较高的诊断价值(曲线下面积分别为0.736、0.731、0.747,P<0.05);COX回归模型结果显示,Tfh比率、Tfh/Tfr及NT-proBNP是IKD合并CAL的影响因素,其OR值及95%CI分别为1.792(1.204~7.552)、2.334(1.745~6.032)、2.072(1.690~8.444),P<0.05。结论NT-proBNP、Tfh比率及Tfh/Tfr对IKD具有较高的诊断作用,且为阿司匹林联合丙种球蛋白治疗IKD伴CAL的影响因素,建议进一步深入临床研究。Objective To analyze the diagnostic effect of follicular helper T(Tfh)cells,follicular regulatory T(Tfr)cells and N-terminal pro-brain natriuretic peptide(NT-proBNP)on incomplete Kawasaki disease(IKD)and the predictive effect on the efficacy of the treatment of gamma globulin combined with aspirin.Methods A total of 272 children with Kawasaki disease who were treated at the First Hospital of Jiaxing from January 2014 to December 2019 were selected as the research objects.According to the diagnostic criteria,they were divided into the complete Kawasaki disease group(CKD group)and the incomplete Kawasaki disease group(IKD group).After the treatment of gamma globulin combined with aspirin,the clinical effects and the changes of Tfh,Tfr and other laboratory biochemical indexes were analyzed.Results After treatment,the total effective rate of children in the CKD group was 95.11%,the total effective rate in the IKD group was 95.45%,and the difference was not statistically significant(χ^(2)=0.016,P>0.05).The regression time of clinical symptoms(fever,mucosal congestion,rash,hand and foot swelling and enlarged lymph nodes)in the IKD group was shorter than that in the CKD group,and the difference was statistically significant(t=7.037,5.421,4.117,5.824 and 6.126,respectively,P<0.05).Before treatment,the incidence of coronary artery lesion(CAL)in the CKD group was lower than that in the IKD group,and the difference was statistically significant(χ^(2)=25.936,P<0.05).There was no statistically significant difference between the two groups in the incidence of CAL after treatment(P>0.05).After treatment,the NT-proBNP,Tfh cells ratio and Tfh/Tfr of children in the IKD group with CAL were higher than those of children in the CKD group with CAL,the Tfr cells ratio was lower than that of children in the CKD group with CAL,and there were statistical significances(t=11.336,5.891,18.613 and 4.221,respectively,P<0.05).The Tfh cells ratio,Tfh/Tfr and NT-proBNP had high diagnostic values for IKD before treatment(AUC=0.736,0.731 and 0.7

关 键 词：川崎病 阿司匹林 丙种球蛋白 疗效 

分 类 号：R725.5[医药卫生—儿科]