2022 年第 2 期 第 17 卷

细胞因子对川崎病患儿发生冠状动脉病变及静脉用丙种球蛋白抵抗的预测价值

Predictive value of cytokines in coronary artery lesion and intravenous immuneglobulin resistance in Kawasaki disease children

作者：郝京霞张英谦李博王华陈敬师

英文作者：Hao Jingxia Zhang Yingqian Li Bo Wang Hua Chen Jingshi

单位：河北省儿童医院心内科河北省小儿心血管重点实验室，石家庄050031

英文单位：Department of Cardiology Hebei Children′s Hospital Hebei Provincial Key Laboratory of Pediatric Cardiovascular Disease Shijiazhuang 050031 China

关键词：川崎病；细胞因子；冠状动脉病变；静脉用丙种球蛋白抵抗

英文关键词：Kawasakidisease;Cytokines;Coronaryarterylesion;Intravenousimmuneglobulinresistance

• 摘要：

• 目的  探讨细胞因子对川崎病患儿发生冠状动脉病变（CAL）及静脉用丙种球蛋白（IVIG）抵抗的预测价值。方法  选取2016年1月至2020年12月河北省儿童医院收治的688例川崎病患儿的临床资料进行回顾性分析。根据是否合并CAL分为CAL组（98例）和非CAL组（590例）；根据是否发生IVIG抵抗分为IVIG敏感组（667例）和IVIG抵抗组（21例）。比较不同组患儿急性期细胞因子白细胞介素6（IL-6）、IL-10、肿瘤坏死因子α（TNF-α）和γ干扰素水平。采用受试者工作特征（ROC）曲线分析细胞因子对川崎病患儿发生CAL及IVIG抵抗的预测价值。结果  CAL组TNF-α水平高于非CAL组［（87.8±16.4）ng/L比（20.8±2.5）ng/L］，差异有统计学意义（P＜0.05）；2组IL-6、IL-10、γ干扰素水平比较，差异均无统计学意义（均P＞0.05）。IVIG抵抗组TNF-α、γ干扰素水平均高于IVIG敏感组［（26.4±4.1）ng/L比（8.6±1.4）ng/L、（20.0±4.4）ng/L比（9.3±1.2）ng/L］，差异均有统计学意义（均P＜0.05）；2组IL-6、IL-10水平差异均无统计学意义（均P＞0.05）。ROC曲线分析结果显示，TNF-α预测川崎病患儿发生CAL的曲线下面积为0.679（95%置信区间：0.566~0.792，P=0.021），截断值为24.515 ng/L，敏感度为50.91%，特异度为66.67%。TNF-α预测川崎病患儿IVIG抵抗的曲线下面积为0.784（95%置信区间：0.644~0.923,P＜0.001），截断值为13.92 ng/L，敏感度为70.00%，特异度为82.69%。γ干扰素预测IVIG抵抗的曲线下面积为0.688（95%置信区间：0.541~0.834，P=0.014），截断值为12.12 ng/L，敏感度为50.00%，特异度为80.77%。结论  TNF-α是川崎病患儿发生CAL的预测因子，TNF-α、γ干扰素是川崎病患儿发生IVIG抵抗的预测因子。

• Objective To investigate the predictive value of cytokines in coronary artery lesion (CAL) and intravenous immuneglobulin (IVIG) resistance in Kawasaki disease children. Methods Clinical data of 688 children with Kawasaki disease admitted to Hebei Children′s Hospital from January 2016 to December 2020 were retrospectively analyzed. According to whether complicated with CAL, they were divided into CAL group (98 cases) and non-CAL group (590 cases). According to whether IVIG resistance occurred, they were divided into IVIG sensitive group (667 cases) and IVIG resistant group (21 cases). Cytokines interleukin-6 (IL-6), IL-10, tumor necrosis factor-α (TNF-α) and γ-interferon levels at acute stage in the children of different groups were compared. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of cytokines in CAL and IVIG resistance in Kawasaki disease children. Results TNF-α level in CAL group was higher than that in non-CAL group［（87.8±16.4）ng/L vs （20.8±2.5）ng/L］（P<0.05）, and there were no significant differences in IL-6, IL-10 and γ-interferon levels between the two groups(all P>0.05). TNF-α and γ-interferon levels in IVIG resistant group were higher than those in IVIG sensitive group［（26.4±4.1）ng/L vs （8.6±1.4）ng/L, （20.0±4.4）ng/L vs （9.3±1.2）ng/L］(both P<0.05), and there were no significant differences in IL-6 and IL-10 levels between the two groups(both P>0.05). ROC curve showed that the area under the curve (AUC) of TNF-α in predicting CAL in children with Kawasaki disease was 0.679 (95% confidence interval: 0.566-0.792, P=0.021), cut-off value was 24.515 ng/L and the sensitivity and specificity were 50.91% and 66.67%, respectively. The AUC of TNF-α in predicting IVIG resistance was 0.784 (95% confidence interval: 0.644-0.923, P<0.001), cut-off value was 13.92 ng/L and the sensitivity and specificity were 70.00% and 82.69%, respectively. The AUC of γ-interferon in predicting IVIG resistance was 0.688 (95% confidence interval: 0.541-0.834, P=0.014), cut-off value was 12.12 ng/L and the sensitivity and specificity were 50.00% and 80.77%, respectively. Conclusions TNF-α is a predictive factor for CAL in children with Kawasaki disease, and TNF-α and γ-interferon are predictive factors for IVIG resistance in children with Kawasaki disease.