静脉注射不同剂量丙种球蛋白联合阿司匹林对川崎病患儿辅助性T细胞17/调节性T细胞失衡的影响  

Effects of different doses of intravenous immunoglobulin combined with aspirin on helper T cell 17/regulatory T cell imbalance in children with Kawasaki disease

作　　者：范双 毛国其 雷芳 宋伍静 FAN Shuang;MAO Guoqi;LEI Fang;SONG Wujing(Department of Pediatrics,Dazu Hospital of Chongqing Medical University,the People's Hospital of Dazu,Chongqing 402360,China)

机构地区：[1]重庆医科大学附属大足医院,重庆市大足区人民医院儿科,重庆402360

出　　处：《世界临床药物》2023年第8期813-819,共7页World Clinical Drug

基　　金：重庆市科技计划项目(DZKJ2020ACC1025)。

摘　　要：目的对比不同剂量静脉注射用丙种球蛋白(intravenous immunoglobulin,IVIG)联合阿司匹林对川崎病(Kawasaki disease,KD)患儿辅助性T细胞17(helper T cell 17,Th17)/调节性T细胞(regulatory T cell,Treg)细胞失衡的影响。方法纳入2016年9月至2020年8月于我院儿科接受治疗的急性期KD患儿73例进行回顾性队列研究。按IVIG不同剂量方案分为对照组(n=35,IVIG 1 g/kg+阿司匹林)和观察组(n=38,IVIG 2 g/kg+阿司匹林)。在治疗前和完成IVIG治疗后3 d内采集外周血,检测Th17/Treg细胞比值及白介素(interleukin,IL)-17、IL-6、IL-23和转化生长因子(transforming growth factor,TGF)-β等水平。结果观察组退热时间和颈部非脓性淋巴结消肿时间短于对照组(P<0.05)。与治疗前相比,两组患儿治疗后Th17细胞比例、Th17/Treg细胞比值及血清IL-17、IL-6、IL-10水平均降低,TGF-β水平升高(P<0.05),且观察组Th17细胞比例、Th17/Treg细胞比值及血清IL-17、IL-10水平变化较对照组显著(P<0.05)。结论静脉注射大剂量IVIG联合阿司匹林对KD患儿疗效确切,能有效改善急性期KD患儿Th17/Treg细胞失衡及免疫功能紊乱,降低血清炎性因子水平,且安全性良好。Objective To compare the effect of different doses of intravenous immunoglobulin(IVIG)combined with aspirin on helper T cell 17(Th17)/regulatory T cell(Treg)cell imbalance in children with Kawasaki disease(KD).Methods A retrospective cohort study was conducted on 73 children with acute KD treated in our department of pediatrics from September 2016 to August 2020.They were divided into control group(n=35,IVIG 1 g/kg+aspirin)and observation group(n=38,IVIG 2 g/kg+aspirin),according to different doses of IVIG.Peripheral blood was collected before treatment and within 3 days after IVIG treatment,and the ratio of Th17/Treg cells,interleukin(IL)-17,IL-6,IL-23 and transforming growth factor(TGF)-βlevels were detected.Results The time of fever reduction and the time of cervical nonpyulent lymph node detumescence in observation group were shorter than those in control group(P<0.05).Compared with before treatment,the proportion of Th17 cells,the ratio of Th17/Treg cells and serum levels of IL-17,IL-6 and IL-10 were decreased in both groups after treatment,while the level of TGF-βwas increased(P<0.05).The changes of Th17 cell proportion,Th17/Treg cell ratio and serum IL-17 and IL-10 levels in observation group were significantly higher than those in control group(P<0.05).Conclusion Intravenous injection of high-dose IVIG combined with aspirin is effective in KD children.It can effectively improve the cell imbalance of Th17/Treg and immune dysfunction in acute KD children,and reduce the level of serum inflammatory factors,with good safety.

关 键 词：大剂量丙种球蛋白 辅助性T细胞17/调节性T细胞失衡 川崎病 

分 类 号：R725.4[医药卫生—儿科]