丙种球蛋白无反应及敏感川崎病患儿血小板、干扰素-γ和白介素-6表达水平及其临床意义  

Expression levels of PLT,IFN-γ and IL-6 in gamma globulin non-responsive and sensitive children with Kawasaki disease and their clinical significance

作　　者：黄蕊[1] 赵红缨 汤颖 杨羡球 杨芳琳 陈凌[1] Huang Rui;Zhao Hongying;Tang Ying;Yang Xianqiu;Yang Fanglin;Chen Ling(Department of Pediatrics,Zhongshan Hospital Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属中山医院儿科,厦门361000

出　　处：《广西医科大学学报》2023年第4期670-675,共6页Journal of Guangxi Medical University

基　　金：福建医学科技青年培育项目(No.18FBQN2016077)。

摘　　要：目的:探讨丙种球蛋白无反应及敏感川崎病患儿血小板(PLT)、干扰素-γ(IFN-γ)、白介素-6(IL-6)表达水平的差异及临床意义。方法:选取2019年5月至2022年6月厦门大学附属中山医院收治的99例川崎病患儿,根据丙种球蛋白治疗反应性分为无反应组24例和敏感组75例,比较两组基线水平及12 h、36 h PLT、IFN-γ、IL-6表达水平。采用Logistic回归分析川崎病丙种球蛋白无反应的相关影响因素,采用受试者工作特征曲线(ROC)分析PLT、IFN-γ、IL-6及联合预测川崎病丙种球蛋白无反应的价值,采用DeLong检验不同方案的预测价值,采用临床决策曲线分析法(DCA)分析PLT+IFN-γ+IL-6方案预测川崎病丙种球蛋白反应性的临床效用。结果:无反应组12 h及36 h PLT、IFN-γ、IL-6表达水平与基线水平比较,差异无统计学意义(P>0.05);敏感组12 h及36 h PLT、IFN-γ、IL-6表达水平均低于基线水平(P<0.05);无反应组基线水平及12 h、36 h PLT、IFN-γ、IL-6表达水平高于敏感组(P<0.05);基线PLT、IFN-γ、IL-6均为川崎病丙种球蛋白无反应的独立相关影响因素(P<0.05);PLT、IFN-γ、IL-6及联合的ROC曲线下面积(AUC)依次为0.818、0.767、0.712、0.915,PLT+IFN-γ+IL-6的AUC高于IFN-γ、IL-6(P<0.05),与PLT比较,差异无统计学意义(P>0.05);采用PLT+IFN-γ+IL-6方案预测川崎病丙种球蛋白无反应具有临床正向的净获益。结论:川崎病丙种球蛋白无反应和敏感患儿PLT、IFN-γ、IL-6表达水平存在显著差异,与患儿治疗反应性有关,联合检测PLT、IFN-γ、IL-6可预测丙种球蛋白治疗反应。Objective:To investigate the differences and clinical significance of platelet(PLT),interferon-γ(IFN-γ),and interleukin-6(IL-6)expression levels between gamma globulin non-responsive and sensitive children with Kawasaki disease.Methods:Ninety-nine Kawasaki disease patients admitted to Zhongshan Hospital Xiamen University from May 2019 to June 2022 were selected and divided into non-responsive group(24 cases)and sensitive group(75 cases)according to the response of gamma globulin treatment.Baseline levels and the expression levels of PLT,IFN-γ and IL-6 at 12 h and 36 h were compared between the two groups.Logistic regression was used to analyze the influencing factors related to gamma globulin non-response in Kawasaki disease,receiver operating characteristic curve(ROC)was used to analyze the value of PLT,IFN-γ,IL-6 and combined prediction of gamma globulin non-response in Kawasaki disease,and DeLong was used to test the predictive value of different regimens.Clinical decision curve analysis(DCA)was used to analyze the clinical utility of PLT+IFN-γ+IL-6 regimen to predict gamma globulin reactivity in Kawasaki disease.Results:The expression levels of PLT,IFN-γand IL-6 at 12 h and 36 h in the non-responsive group were not statistically significant compared with baseline level(P>0.05);the expression levels of PLT,IFN-γ and IL-6 in sensitive group at 12 h and 36 h were lower than baseline levels(P<0.05);baseline level and expression levels of PLT,IFN-γand IL-6 at 12 h and 36 h in non-responsive group were higher than those in sensitive group(P<0.05);baseline PLT,IFN-γ and IL-6 were all independent relevant influencing factors for non-response to Kawasaki disease gamma globulin(P<0.05);the area under the ROC curve(AUC)of PLT,IFN-γ,IL-6 and combination was 0.818,0.767,0.712 and 0.915,respectively,the AUC of PLT+IFN-γ+IL-6 was higher than that of IFN-γ and IL-6(P<0.05),but the difference with PLT was not statistically significant(P>0.05);there was a net positive clinical benefit of using the PLT+IFN-γ+IL-6 r

关 键 词：川崎病 丙种球蛋白 反应性 PLT IFN-Γ IL-6 

分 类 号：R725.9[医药卫生—儿科]