| 摘要: |
| 目的：探讨静脉注射免疫球蛋白（IVIG）敏感和不敏感型川崎病（KD）患儿血小板miR-223和血清炎症因子的表达差异及临床意义。方法：选取大足区人民医院2018年4月至2020年11月收治的182例不完全KD患儿，根据IVIG治疗结局分为IVIG敏感组（150例）和IVIG不敏感组（32例），采用实时荧光定量聚合酶链式反应（PCR）法检测血小板miR-223表达，采用酶联免疫吸附试剂盒检测血清炎症指标，比较两组患儿血小板miR-223、血清炎症因子水平及血常规。结果：与IVIG敏感组比较，IVIG不敏感组患儿血小板miR-223和血清肿瘤坏死因子α（TNF-α）、白细胞介素（IL）-1β、IL-6水平升高（P均<0.05）。多因素Logistic分析结果显示，C反应蛋白（CRP）、中性粒细胞和淋巴细胞比值（NLR）、血小板miR-223是影响KD患儿发生IVIG不敏感的独立危险因素（P<0.05）。受试者工作特征（ROC）曲线显示，血小板miR-223、CRP、NLR及miR-223+CRP+NLR诊断KD患儿IVIG敏感性的曲线下面积分别为0.964（0.940~0.988）、0.811（0.714~0.907）、0.903（0.846~0.959）、0.984（0.968~1.000）。Pearson相关性分析显示，血小板miR-223与IL-1β、TNF-α、IL-6呈正相关（r分别为0.713、0.744、0.651，P<0.01）。此外，冠状动脉病变组患儿血小板miR-223表达量高于无冠状动脉病变组（P<0.01）。结论：联合检测血小板miR-223、NLR、CRP水平用于预测KD患儿IVIG治疗结局具有较高的临床价值，且血小板miR-223和血清炎症因子水平及冠状动脉病变风险密切相关 |
| 关键词: 静脉注射免疫球蛋白 川崎病 miR-223 炎症因子 冠状动脉病变 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2022.07.008 |
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| 基金项目:重庆市科技计划项目,编号2017039。 |
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| Expression Differences and Clinical Significance of Platelet miR-223 and Serum Inflammatory Factors in Children with Intravenous Immunoglobulin-Sensitive and Insensitive Kawasaki Disease |
| Lei Fang, Wang Tingting, Gong Xia, Zhang Juan |
| (Dazu Hospital of the First Affiliated Hospital of Chongqing Medical University, Chongqing Dazu District, the People’s Hospital of Dazu, Chongqing 402360, China) |
| Abstract: |
| Objective: To probe into the expression differences and clinical significance of platelet miR-223 and serum inflammatory factors in children with intravenous immunoglobulin (IVIG)-sensitive and insensitive Kawasaki disease (KD). Methods: A total of 182 children with incomplete KD admitted into the People’s Hospital of Dazu from Apr. 2018 to Nov. 2020 were extracted and divided into IVIG-sensitive group (n=150) and IVIG-insensitive group (n=32) according to the IVIG treatment outcome. Expression of platelet miR-223 was detected by real-time fluorescence quantitative polymerase chain reaction (PCR), and serum inflammatory factors were detected by enzyme-linked immunosorbent assay kit. The levels of platelet miR-223, serum inflammatory factors and blood routine were compared between two groups. Results: Compared with the IVIG sensitive group, the platelet miR-223, serum tumor necrosis factor α (TNF-α), interleukin (IL)-1β, and IL-6 increased significantly in the IVIG insensitive group (P<0.05). Multivariate Logistic analysis results showed that C-reactive protein (CRP), neutrophils/lymphocytes ratio (NLR) and platelet miR-223 were independent risk factors for IVIG insensitivity in children with KD (P<0.05). The receiver operating characteristic (ROC) curve showed that the areas under the curve of platelet miR-223, CRP, NLR and miR-223+CRP+NLR in the diagnosis of IVIG sensitivity in children with KD were respectively 0.964 (from 0.940 to 0.988), 0.811 (from 0.714 to 0.907), 0.903 (from 0.846 to 0.959) and 0.984 (from 0.968 to 1.000). Pearson correlation analysis showed that platelet miR-223 was positively correlated with IL-1β, TNF-α and IL-6 (r was respectively 0.713, 0.744 and 0.651, P<0.01). Meanwhile, the expression level of platelet miR-223 in children with coronary artery disease group was higher than that in the non-coronary artery disease group (P<0.01). Conclusion: Combined measurement of platelet miR-223, NLR and CRP levels is of high clinical value in predicting the of IVIG treatment outcome in children with KD, and platelet miR-223 is closely related to the level of serum inflammatory factors and the risk of coronary artery disease. |
| Key words: intravenous immunoglobulin Kawasaki disease miR-223 inflammatory factors coronary artery disease |
