血清可溶性肿瘤坏死因子受体Ⅱ/Ⅰ比值、白细胞介素-17联合心电图诊断川崎病患儿急性期冠状动脉损伤的价值  

Value of serum sTNFRⅡ/Ⅰ,IL-17 combined with ECG in diagnosis of coronary artery injury in children with Kawasaki disease in acute phase

作　　者：杨敏[1,2] 刘鑫 YANG Min;LIU Xin(Department of Cardiovascular Medicine,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Cardiac Electrophysiology,Xi’an People’s Hospital,Xi’an 710004,China;ECG Room,Cardiovascular Hospital,Xi’an Ninth Hospital,Xi’an 710054,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西西安710061 [2]西安市人民医院心电生理科,陕西西安710004 [3]西安市第九医院心血管病院心电图室,陕西西安710054

出　　处：《陕西医学杂志》2025年第3期338-342,共5页Shaanxi Medical Journal

基　　金：陕西省重点研发计划项目(S2022-YF-YBSF-1204,2017ZDCXL-SF-02-04-02)。

摘　　要：目的:探究血清可溶性肿瘤坏死因子受体Ⅱ/Ⅰ(sTNFRⅡ/Ⅰ)比值、白细胞介素-17(IL-17)水平联合心电图(ECG)诊断川崎病患儿急性期冠状动脉损伤的价值。方法:选取川崎病急性期患儿81例为研究对象,均接受超声心动图检查,根据是否合并冠状动脉损伤分为损伤组(33例)和正常组(48例)。比较两组临床指标、ECG相关参数及血清sTNFRⅡ、sTNFRⅠ、IL-17水平及sTNFRⅡ/Ⅰ比值,分析冠状动脉损伤影响因素并据此建立诊断模型,验证模型的诊断价值。结果:损伤组患儿发热持续时间≥10 d、静脉注射丙种球蛋白治疗延迟、丙种球蛋白抵抗占比高于正常组(均P<0.05)。损伤组QT间期离散度(QTd)、校正QT间期离散度(QTcd)高于正常组,窦性心动过速、平均心率升高或异常占比高于正常组(均P<0.05)。与正常组比较,损伤组sTNFRⅡ、sTNFRⅠ、IL-17水平及sTNFRⅡ/Ⅰ比值升高(均P<0.05)。静脉注射丙种球蛋白治疗延迟、QTd、QTcd、平均心率升高或异常、sTNFRⅡ/Ⅰ比值、IL-17是对川崎病患儿急性期冠状动脉损伤的影响因素(均P<0.05)。建立的川崎病急性期冠状动脉损伤诊断模型具有良好的诊断中价值(P<0.05)。结论:血清sTNFRⅡ/Ⅰ比值、IL-17水平对川崎病患儿急性期冠状动脉损伤具有显著影响,联合ECG能够进行有效诊断。Objective:To explore the value of serum soluble tumor necrosis factor receptorⅡ/Ⅰ(sTNFRⅡ/Ⅰ)ratio,interleukin-17(IL-17)level combined with electrocardiogram(ECG)in diagnosing coronary artery lesions in children with Kawasaki disease in the acute phase.Methods:A total of 81 children in the acute phase of Kawasaki disease were selected for the study.All children underwent echocardiography and were divided into two groups based on whether they had coronary artery lesions:the injury group(33 cases)and the normal group(48 cases).Clinical indicators,ECG parameters,serum sTNFRⅡ/Ⅰratio and IL-17 level were compared between the two groups.The influencing factors of coronary artery injury were analyzed to establish a diagnostic model,and the diagnostic value of model was verified.Results:Compared with the normal group,the injury group had a significantly higher proportion of children with fever duration≥10 days,delayed intravenous gamma globulin treatment,and gamma globulin resistance(all P<0.05).The QTd and QTcd in the injury group were higher than those in the normal group,and the proportion of sinus tachycardia and average heart rate increased or abnormal were higher than those in the normal group(all P<0.05).Compared with the normal group,the levels of sTNFRⅡ,sTNFRⅠ,IL-17 and sTNFRⅡ/Ⅰratio were increased in the injury group(all P<0.05).Delayed intravenous gamma globulin treatment,QTd,QTcd,increased or abnormal mean heart rate,sTNFRⅡ/Ⅰratio and IL-17 were the influencing factors of coronary artery injury in children with Kawasaki disease in the acute phase(all P<0.05).The established diagnostic model of coronary artery injury in the acute phase of Kawasaki disease had a good diagnostic value(P<0.05).Conclusion:Serum sTNFRⅡ/Ⅰratio and IL-17 level have a significant effect on coronary artery injury in children with Kawasaki disease in the acute phase,and their combination with ECG can effectively diagnose coronary artery injury.

关 键 词：川崎病 可溶性肿瘤坏死因子受体Ⅱ/Ⅰ 白细胞介素-17 心电图 冠状动脉损伤 诊断价值 

分 类 号：R725.4[医药卫生—儿科]