淋巴细胞亚群、炎症因子和氨基末端B型钠尿肽原联合检测诊断川崎病  

Roles of lymphocyte subsets,inflammatory factors and NT-proBNP in diagnosis of Kawasaki disease

作　　者：刘亚楠[1] 夏敏[1] 胡韶华 郑月 张泓[1] LIU Yanan;XIA Min;HU Shaohua;ZHENG Yue;ZHANG Hong(Department of Clinical Laboratory,Children's Hospital of Shanghai,Shanghai 200040,China)

机构地区：[1]上海市儿童医院检验科,上海200040

出　　处：《检验医学》2023年第6期532-537,共6页Laboratory Medicine

摘　　要：目的分析川崎病(KD)急性期患儿淋巴细胞亚群和相关炎症因子、心脏标志物的变化,探讨其在KD诊断中的临床价值。方法选取2016年10月—2019年3月上海市儿童医院222例KD急性期患儿(KD组)和177例感染发热的非KD患儿(感染发热组)。采用流式荧光法检测患儿外周血13种炎症因子[白细胞介素(IL)-8、IL-1β、IL-2、IL-6、IL-10、IL-4、IL-5、IL-12P70、IL-17A、IL-18、肿瘤坏死因子α(TNF-α)、γ-干扰素(INF-γ)、sCD25]水平,采用流式细胞术检测外周血淋巴细胞。比较KD组与感染发热组外周血炎症因子和淋巴细胞水平的差异,并比较KD患儿丙种球蛋白静脉治疗(IVIG)前后各炎症因子水平的变化。采用Spearman相关分析评价145例KD患儿心脏标志物[心肌肌钙蛋白I(cTnI)、肌红蛋白(MYO)、氨基末端B型钠尿肽原(NT-proBNP)]与淋巴细胞亚群和炎症因子的相关性。结果与感染发热组比较,除IL-2外,KD组其他炎症因子水平均升高(P<0.05);外周血CD3^(+)CD4^(+)T细胞百分比、CD16^(+)CD56^(+)自然杀伤细胞百分比、CD4/CD8比值升高,CD3^(+)CD8^(+)T细胞百分比下降(P<0.05);CD16^(+)CD56^(+)自然杀伤细胞绝对值升高,CD3^(+)CD8^(+)T细胞绝对值下降(P<0.05)。KD患儿治疗后血清IL-8、IL-1β、IL-2、IL-6、IL-10、IL-18、TNF-α、sCD25均明显降低(P<0.05)。KD患儿外周血cTnI、MYO未见明显升高;有62%的患儿外周血NTproBNP明显升高,与IL-6、IL-10、IL-17A、IL-18、TNF-α、INF-γ、sCD25、CD19^(+)B细胞百分比和绝对值、CD4/CD8比值呈正相关,与CD3^(+)CD8^(+)T细胞百分比呈负相关。结论KD急性期患儿存在炎症因子上调和淋巴细胞亚群比例失衡,NT-proBNP联合免疫细胞和炎症因子检测可更好地辅助临床诊疗。Objective To investigate the changes and roles of lymphocyte subsets,inflammatory factors and myocardial marker in children with acute Kawasaki disease(KD).Methods From October 2016 to March 2019,222 acute KD children and 177 non-KD children with infection and fever were enrolled from Children's Hospital of Shanghai.Lymphocytes were determined by flow cytometry.The levels of 13 inflammatory factors[interleukin(IL)-8,IL-1β,IL-2,IL-6,IL-10,IL-4,IL-5,IL-12P70,IL-17A,IL-18,tumor necrosis factor-alpha(TNF-α),interferon-gamma(INF-γ)and sCD25]were determined flow cytometry and immunofluorescence technique Peripheral blood lymphocytes were determined by flow cytometry.The expressions of inflammatory cytokines and lymphocytes in peripheral blood of children with KD in acute phase and non-KD patients with feverinfected were compared.The expressions of inflammatory factors were compared before and after intravenous injection gamma globulin(IVIG)in children with KD.The changes of cardiac markers,including cardiac troponin I(cTnI),myoglobin(MYO)and N-terminal pro-B-type natriuretic peptide(NT-proBNP),in 145 children with KD in acute phase were determined,and the correlations were analyzed.Results Compared with children with infection and fever,other inflammatory factors except IL-2 were increased in children with KD(P<0.05).Peripheral blood CD3^(+)CD4^(+)T cell percentage,CD16^(+)CD56^(+)natural killer cell percentage,CD4/CD8 were increased,and CD3^(+)CD8^(+)T cell percentage was decreased(P<0.05).The absolute value of CD16^(+)CD56^(+)natural killer cells was increased,and the absolute value of CD3^(+)CD8^(+)T cells was decreased(P<0.05).After treatment,serum IL-8,IL-1β,IL-2,IL-6,IL-10,IL-18,TNF-αand sCD25 were decreased(P<0.05).There was no significant increase of cTnI and MYO in peripheral blood of children with KD.There was a significant increase of NT-proBNP in peripheral blood of 62%children,which was positively correlated with IL-6,IL-10,IL-17A,IL-18,TNF-α,INF-γ,sCD25,the percentage and absolute value of CD19^(+)

关 键 词：淋巴细胞亚群 炎症因子 氨基末端B型钠尿肽原 川崎病 

分 类 号：R446.1[医药卫生—诊断学]