2024 年第 8 期 第 0 卷

合并冠状动脉损伤的川崎病患儿免疫系统变化特点单中心研究

Research on the characteristics of immune system changes in pediatric patients with Kawasaki disease complicated with coronary artery lesions in a single center

作者：刘露冯琪娄美娜王永丽李会张英谦

英文作者：Liu Lu Feng Qi Lou Meina Wang Yongli Li Hui Zhang Yingqian

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 Province Key Laboratory of Pediatric Cardiovascular Disease Shijiazhuang 050031 China

关键词：川崎病；冠状动脉损伤；免疫系统；细胞因子；淋巴细胞；免疫球蛋白

英文关键词：Kawasakidisease;Coronaryarterylesions;Immunesystem;Cytokine;Lymphocyte; Immunoglobulin

• 摘要：

• 目的 探讨合并冠状动脉损伤（CAL）的川崎病患儿免疫系统变化特点，为其规范化诊治提供依据。方法 选取2021年8月至2023年5月河北省儿童医院心内科收治的川崎病患儿238例作为川崎病组，根据CAL情况分为CAL亚组（61例）和非CAL（NCAL）亚组（177例）。选取同期诊断为支气管炎或上呼吸道感染的发热患儿102例作为对照组。比较各组患儿基本信息和实验室检查指标。采用Logistic回归方法分析川崎病患儿发生CAL的危险因素。基于相关变量建立预测发生CAL风险的列线图模型，应用受试者工作特征（ROC）曲线评价列线图性能及各指标的预测效能。结果 CAL亚组患儿男性比例大于、病程长于、血小板计数水平高于NCAL亚组（均P<0.05）。川崎病组白细胞介素2（IL-2）、IL-6、IL-10、IL-5、IL-8、补体C3、C4、总B细胞水平均明显高于对照组，免疫球蛋白（Ig）A、IgG、IgM、总T细胞、CD+8 T细胞、γδT细胞水平低于对照组；CAL亚组IL-2、IL-1β、α干扰素、IgA、IgG、IgM、自然杀伤细胞水平均明显高于NCAL亚组，补体C3、C4、总T细胞、CD+8 T细胞水平低于NCAL亚组（均P<0.05）。多因素Logistic回归分析结果显示CD+8 T细胞、补体C3水平降低，IgG、自然杀伤细胞水平升高是CAL的独立危险因素（均P<0.05）。列线图对发生CAL的预测与实际概率较吻合。CD+8 T细胞、自然杀伤细胞、IgG、补体C3四者联合预测CAL的ROC曲线下面积为0.866（95%置信区间：0.804～0.913），大于各指标单独预测（0.800、0.631、0.653、0.651）。结论 合并CAL的川崎病患儿免疫因子自然杀伤细胞、CD+8 T细胞、IgG、补体C3水平变化明显，这种变化可能参与了川崎病和CAL的发生。

• Objective To investigate the characteristics of immune system changes in pediatric patients with Kawasaki disease （KD） complicated with coronary artery lesion (CAL), and to provide a basis for its standardized diagnosis and treatment. Methods  A total of 238 children with KD admitted to the Department of Cardiology, Hebei Children′s Hospital, Hebei Province from August 2021 to May 2023 were selected as the KD group. According to CAL status, the patients were divided into CAL subgroup (61 cases) and non-CAL (NCAL) subgroup (177 cases). A total of 102 pediatric patients with fever who were diagnosed with bronchitis or upper respiratory tract infection during the same period were selected as the control group. The basic information and laboratory examination indexes of pediatric patients in each group were compared. Logistic regression method was used to analyze the risk factors of CAL in pediatric patients with KD. Based on the relevant variables, a nomogram model was established to predict the risk of CAL, and the receiver operating characteristic (ROC) curve was used to evaluate the performance of the nomogram and the predictive efficiency of each index. Results  The proportion of males in the CAL subgroup was higher, the disease duration was longer, and the platelet count level was higher than those in the NCAL subgroup(all P<0.05). The levels of interleukin-2 (IL-2), IL-6, IL-10, IL-5, IL-8, complement C3, C4, and total B cells in the KD group were significantly higher than those in the control group; the levels of immunoglobulin (Ig) A, IgG, IgM, total T cells, CD+8 T cells, γδT cells were lower than those in the control group; the levels of IL-2, IL-1β, interferon-α, IgA, IgG, IgM, and natural killer cells in CAL subgroups were significantly higher than those in the NCAL subgroup, while the levels of complement C3, C4, total T cells, and CD+8 T cells were lower than those in the NCAL subgroup (all P<0.05). Multivariate Logistic regression analysis showed that the decreased levels of CD+8 T cells and complement C3 levels, as well as the increased levels of IgG and natural killer cell levels were independent risk factors for CAL(all P<0.05). The prediction of CAL by the nomogram was consistent with the actual probability. The area under the curve of ROC for the combined prediction of CAL by CD+8 T cells, natural killer cells, IgG, and complement C3 was 0.866(95% confidence interval: 0.804-0.913), which was greater than the individual predictions of each indicator (0.800, 0.631, 0.653, 0.651). Conclusion  The changes of immune factors of natural killer cells, CD+8 T cells, IgG and complement C3 is significant in patients with KD complicated with CAL, and this change may be involved in the pathogenesis of KD and CAL.