摘要目的 探讨川崎病患儿血清白细胞介素(IL)-33、21、17、6水平及抗心磷脂抗体(ACA)-IgG、ACA-IgM和抗血管内皮细胞抗体(AECA)-IgM阳性在川崎病的诊断及预测冠状动脉损害中的意义.方法 选取川崎病患儿70例(川崎病组),按照心脏超声是否异常分为超声异常组(11例)和超声正常组(59例);另外选取50例上呼吸道感染或支气管炎患儿作为对照组.均检测血清IL-33、21、17、6水平及ACA-IgG、ACA-IgM、AECA-IgM阳性情况.结果 川崎病组急性期血清IL-33、21、17、6水平均明显高于对照组[(127.43±10.87)ng/L比(69.67±6.38)ng/L、(130.43±11.22)ng/L比(87.56±7.76)ng/L、(1243.38±612.08)ng/L比(397.26±182.16)ng/L、(438.35±101.78)ng/L比(213.74±104.52)ng/L],ACA-IgG、IgM和AECA-IgM阳性率均明显高于对照组[37.1%(26/70)比8.0%(4/50)、32.9%(23/70)比6.0%(3/50)、34.3%(24/70)比8.0%(4/50)],差异有统计学意义(P<0.01).超声异常组急性期血清IL-33、21、17、6水平均明显高于超声正常组[(135.92±11.56)ng/L比(123.48±10.14)ng/L、(138.29±11.86)ng/L比(128.08±10.94)ng/L、(2042.47±968.43)ng/L比(1096.59±502.82)ng/L、(495.58±103.04)ng/L比(402.67±98.26)ng/L],ACA-IgG、IgM和AECA-IgM阳性率均明显高于超声正常组[7/11比32.2%(19/59)、8/11比25.4%(15/59)、7/11比28.8%(17/59)],差异有统计学意义(P<0.01或<0.05).川崎病组急性期血清IL-33、21、17、6水平均明显高于亚急性期[(127.43±10.87)ng/L比(94.48±8.56)ng/L、(130.43±11.22)ng/L比(91.78±8.03)ng/L、(1243.38±612.08)ng/L比(527.12±236.94)ng/L、(438.35±101.78)ng/L比(308.41±144.09)ng/L],差异有统计学意义(P<0.01).结论 IL-33、21、17、6及ACA-IgG、ACA-IgM、AECA-IgM参与川崎病血管炎及冠状动脉损害过程,可以辅助川崎病早期诊断及预测冠状动脉损害的发生.

abstractsObjective To explore the significance of serum levels of interleukin(IL)-33,21,17, 6,the positive rates of anti-cardiolipin antibody(ACA)-IgG,ACA-IgM and anti endothelial cell antibody (AECA)-IgM in diagnosis of Kawasaki disease and prediction of coronary artery lesions. Methods Seventy children with Kawasaki disease were selected as Kawasaki disease group,and the children were divided into abnormal ultrasonic group(11 cases)and normal ultrasonic group(59 cases)according to the result of cardiac ultrasound. Fifty children with upper respiratory tract infection or bronchitis were selected as control group.The serum levels of IL-33,21,17,6 and positive rates of ACA-IgG,ACA-IgM, AECA-IgM were detected.Results The serum levels of IL-33,21,17 and 6 in Kawasaki disease acute stage were significantly higher than those in control group:(127.43 ± 10.87)ng/L vs.(69.67 ± 6.38)ng/L, (130.43 ± 11.22) ng/L vs. (87.56 ± 7.76) ng/L, (1 243.38 ± 612.08) ng/L vs. (397.26 ± 182.16) ng/L, (438.35 ± 101.78)ng/L vs.(213.74 ± 104.52)ng/L;the positive rates of ACA-IgG,ACA-IgM and AECA-IgM were significantly higher than those in control group: 37.1%(26/70)vs.8.0%(4/50),32.9%(23/70) vs.6.0%(3/50)and 34.3%(24/70)vs.8.0%(4/50),and there were statistical differences(P<0.01).The acute stage serum levels of IL-33, 21, 17 and 6 in abnormal ultrasonic group were significantly higher than those in normal ultrasonic group:(135.92 ± 11.56)ng/L vs.(123.48 ± 10.14)ng/L,(138.29 ± 11.86) ng/L vs.(128.08 ± 10.94)ng/L,(2 042.47 ± 968.43)ng/L vs.(1 096.59 ± 502.82)ng/L,(495.58 ± 103.04) ng/L vs. (402.67 ± 98.26) ng/L; the positive rates of ACA-IgG, ACA-IgM and AECA-IgM were significantly higher than those in normal ultrasonic group:7/11 vs.32.2%(19/59),8/11 vs.25.4%(15/59) and 7/11 vs. 28.8% (17/59), and there were statistical differences (P < 0.01 or <0.05). In Kawasaki disease, the acute stage serum levels of IL-33, 21, 17 and 6 were significantly higher than those in subacute stage:(127.43 ± 10.87)ng/L vs.(94.48 ± 8.56)ng/L,(130.43 ± 11.22)ng/L vs.(91.78 ± 8.03) ng/L, (1 243.38 ± 612.08) ng/L vs. (527.12 ± 236.94) ng/L and (438.35 ± 101.78) ng/L vs. (308.41 ± 144.09)ng/L,and there were statistical differences(P<0.01).Conclusions IL-33,21,17,6 and ACA-IgG, ACA-IgM, AECA-IgM participates in the process of Kawasaki disease vasculitis and coronary artery damage,which can assist the early diagnosis of Kawasaki disease and predict the coronary artery lesions.