血清细胞因子鉴别儿童川崎病与感染发热性疾病的临床价值  

Clinical value of serum cytokines in differentiating Kawasaki disease from infectious febrile diseases in children

作　　者：陈妙月 叶蓓 叶萃英 CHEN Miao-yue;YE Bei;YE Cui-ying(Department of Internal Medicine,Hangzhou Children's Hospital,Zhejiang 310014,China;不详)

机构地区：[1]杭州市儿童医院内科,浙江杭州310014 [2]杭州市儿童医院检验科

出　　处：《中国妇幼保健》2023年第15期2767-2770,共4页Maternal and Child Health Care of China

基　　金：浙江省杭州市卫生科技计划项目(A20200778)。

摘　　要：目的 探讨川崎病患儿血清细胞因子表达情况及与川崎病的相关性。方法 选取2019年4月1日—2021年2月28日在杭州市儿童医院就诊的78例发热患儿为研究对象。其中39例川崎病患儿为研究组,39例感染发热性疾病患儿为对照组。采用多重微球流式免疫荧光发光法测定两组患儿血清白细胞介素-1β(IL-1β)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)水平,评估诊断效能。结果 研究组IL-6水平为200.1(98.4,359.4) pg/ml,对照组IL-6水平为46.0(18.7,80.6) pg/ml,研究组IL-6水平较对照组显著升高(Z=-5.721,P<0.05);研究组TNF-α水平为14.3(5.4,29.8)pg/ml,对照组TNF-α水平为7.9(4.0,14.3)pg/ml,研究组TNF-α水平明显高于对照组(Z=-2.304,P<0.05)。logistic回归分析结果显示:IL-6水平升高是川崎病患病的独立风险因素(OR=0.978,95%CI:0.968~0.989)。受试者工作特征(ROC)曲线显示:IL-6预测川崎病的灵敏度为84.6%,特异度为79.5%,最佳截断值为82.3 pg/ml,ROC曲线下面积(AUC)为0.876。结论 对于发热患儿,血清IL-6水平具有潜在的临床诊断评估价值,有利于鉴别儿童川崎病与感染发热性疾病。Objective To investigate the expressions of serum cytokines in children with Kawasaki disease and the correlations with Kawasaki disease.Methods From April 1st,2019 to February 28th,2021,78 children with fever were selected from Hangzhou Children's Hospital as study object,including 39 children with Kawasaki disease in study group and 39 children with infectious febrile diseases in control group.The levels of serum interleukin-1β(IL-1β),interleukin-2(IL-2),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ) in the two groups were measured by multiple microsphere flow immunofluorescence assay,and the diagnostic efficacy was evaluated.Results The level of IL-6 in study group was 200.1(98.4,359.4) pg/ml,the level of IL-6 in control group was 46.0(18.7,80.6) pg/ml,the level of IL-6 in study group was higher than that in control group(Z=-5.721,P<0.05);the level of TNF-α in study group was 14.3(5.4,29.8) pg/ml,the level of TNF-α in control group was 7.9(4.0,14.3) pg/ml,the level of TNF-α in study group was higher than that in control group(Z=-2.304,P<0.05).Logistic regression analysis showed that increase of IL-6 level was an independent risk factor for Kawasaki disease(OR=0.978,95% CI:0.968-0.989).ROC curve showed that the sensitivity and specificity of IL-6 in predicting Kawasaki disease were 84.6% and 79.5%,respectively,the optimal cutoff value was 82.3 pg/ml,and the area under ROC curve was 0.876.Conclusion For the children with fever,serum IL-6 level has potential clinical diagnosis and evaluation value,which is helpful to differentiate Kawasaki disease from infectious febrile diseases in children.

关 键 词：川崎病 细胞因子 感染发热性疾病 儿童 

分 类 号：R725.4[医药卫生—儿科]