[1]杨 敏,刘 鑫.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[J].陕西医学杂志,2025,54(3):338-342.[doi:DOI:10.3969/j.issn.1000-7377.2025.03.010]
　YANG Min,LIU Xin.Value of serum sTNFR Ⅱ/Ⅰ,IL-17 combined with ECG in diagnosis of coronary artery injury in children with Kawasaki disease in acute phase[J].,2025,54(3):338-342.[doi:DOI:10.3969/j.issn.1000-7377.2025.03.010]
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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
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年3期
页码:
338-342
栏目:
临床研究
出版日期:
2025-03-05

文章信息/Info

Title:
Value of serum sTNFR Ⅱ/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3
(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)
Author(s):
YANG Min1; 2; LIU Xin3
(1.Department of Cardiovascular Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China; 2.Department of Cardiac Electrophysiology,Xi'an People's Hospital,Xi'an 710004,China; 3.ECG Room,Cardiovascular Hospital,Xi'an Ninth Hospital,Xi'an 710054,China)
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
Keywords:
Kawasaki disease;  Soluble tumor necrosis factor receptor Ⅱ/Ⅰ;  Interleukin-17;  Electrocardiogram;  Coronary artery lesion;  Diagnostic value
分类号:
R 725.4
DOI:
DOI:10.3969/j.issn.1000-7377.2025.03.010
文献标志码:
A
摘要:
目的:探究血清可溶性肿瘤坏死因子受体Ⅱ/Ⅰ(sTNFR Ⅱ/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sTNFR Ⅱ、sTNFR Ⅰ、IL-17水平及sTNFR Ⅱ/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sTNFR Ⅱ、sTNFR Ⅰ、IL-17水平及sTNFR Ⅱ/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、sTNFR Ⅱ/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sTNFR Ⅱ/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。
Abstract:
Objective:To explore the value of serum soluble tumor necrosis factor receptor Ⅱ/Ⅰ(sTNFR Ⅱ/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 sTNFR Ⅱ/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 sTNFR Ⅱ,sTNFR Ⅰ,IL-17 and sTNFR Ⅱ/Ⅰ ratio were increased in the injury group(all P<0.05).Delayed intravenous gamma globulin treatment,QTd,QTcd,increased or abnormal mean heart rate,sTNFR Ⅱ/Ⅰ ratio 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 sTNFR Ⅱ/Ⅰ ratio 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.

参考文献/References:

[1] SHARMA C,GANIGARA M,GALEOTTI C,et al.Multisystem inflammatory syndrome in children and Kawasaki disease:A critical comparison[J].Nat Rev Rheumatol,2021,17(12):731-748.
[2] 付佳,张勇,刘婧,等.30例川崎病患儿主动脉造影临床分析[J].介入放射学杂志,2024,33(2):126-129.
[3] LU Y,GUO Y,SI F,et al.Predictive value of heart rate deceleration capacity on coronary artery lesion in acute phase of Kawasaki disease[J].Sci Rep,2020,10(1):10211.
[4] 查旋,许周媚.免疫球蛋白输注速度对川崎病患儿的疗效和安全性比较[J].中国药师,2024,27(7):1149-1154.
[5] VELAYUTHAN R,PARALE C,BALAGURU S.Unusual electrocardiogram findings after cardioversion[J].JAMA Intern Med,2023,183(1):76-77.
[6] DONG T,BEVAN G,ZIDAR D A,et al.Soluble tumor necrosis factor receptor 1 is associated with cardiovascular risk in persons with coronary artery calcium score of zero[J].Pathog Immun,2021,6(2):135-148.
[7] TROVATO E,RUBDGNI P,PRIGNANO F.Place in therapy of anti-IL-17 and 23 in psoriasis according to the severity of comorbidities:A focus on cardiovascular disease and metabolic syndrome[J].Expert Opin Biol Ther,2022,22(12):1443-1448.
[8] BELTRAN J V B,LIN F P,CHANG C L,et al.Single-cell meta-analysis of neutrophil activation in kawasaki disease and multisystem inflammatory syndrome in children reveals potential shared immunological drivers[J].Circulation,2023,148(22):1778-1796.
[9] 颜凯,林平,尧战勇.英夫利昔单抗联合阿托伐他汀治疗川崎病效果及对患儿血清NT-proBNP、iNOS影响[J].临床误诊误治,2022,35(3):36-39.
[10] CHEN L,SHANNUAN Z,DONG Z,et al.NFIL3 aggravates human coronary artery endothelial cell injury by promoting ITGAM transcription in Kawasaki disease[J].Hematology,2023,28(1):2277502.
[11] 马思文,侯海洋,侯海维,等.川崎病急性期患儿血清Cav-1、sTNFRⅡ/Ⅰ比值与冠状动脉损伤的关系[J].中国妇幼健康研究,2022,33(4):56-62.
[12] ZHANG Z,TANG Z,MA X,et al.TAOK1 negatively regulates IL-17-mediated signaling and inflammation[J].Cell Mol Immunol,2018,15(8):794-802.
[13] 华勇,张勇.5岁以上川崎病儿童合并冠状动脉病变的预测指标与风险模型构建[J].中国当代儿科杂志,2024,26(5):461-468.
[14] 王从贵,彭海琳,熊伟.血清多配体蛋白聚糖1、血管紧张素转换酶2与川崎病患儿冠状动脉损害和临床疗效的关系[J].广东医学,2024,45(6):666-671.
[15] ZHANG P,LIANG T,WANG X,et al.Serum-derived exosomes from patients with coronary artery disease induce endothelial injury and inflammation in human umbilical vein endothelial cells[J].Int Heart J,2021,62(2):396-406.
[16] 顾民华,顾勇.川芎嗪通过miR-34a对氧化型低密度脂蛋白诱导的冠状动脉内皮细胞损伤的保护作用[J].陕西中医,2023,44(9):1169-1172.
[17] 张永兰,杜忠东,付培培.不同剂量静脉丙种球蛋白或加甲泼尼龙治疗无反应川崎病患儿疗效观察[J].中国循证儿科杂志,2013,8(3):220-223.
[18] 宋美璇,刘斌,刘东.川崎病患儿丙种球蛋白耐药列线图模型的构建与验证[J].中国现代医学杂志,2023,33(23):52-60.
[19] DENG L,WANG T,DUAN Y,et al.Neutrophil percentage-to-albumin ratio is a potential marker of intravenous immunoglobulin resistance in Kawasaki disease[J].Sci Rep,2024,14(1):15232.
[20] ESHRAGHI A,HOSEINJANI E,JALALYAZDI M,et al.QT interval and P wave dispersion in slow coronary flow phenomenon[J].ARYA Atheroscler,2018,14(5):212-217.
[21] 赵萌,杨轶童,李翰文,等.肠道微生物菌群与川崎病关系研究进展[J].陕西医学杂志,2024,53(2):270-273,281.
[22] RODRIGUEZ-JIMENEZ A E,CRUZ-INERARITY H,NEGRIN-VALDES T,et al.Corrected QT-interval dispersion:An electrocardiographic tool to predict recurrence of myocardial infarction[J].MEDICC Rev,2019,21(2-3):22-25.
[23] ROH D E,LIM Y T,KWON J E,et al.Kawasaki disease following SARS-CoV-2 infection:Stronger inflammation with no increase in cardiac complications[J].Front Pediatr,2022,10:1036306.
[24] 陆月.sTNFRⅡ-gAD融合蛋白聚合体表达、制备及生物学特性研究[D].温州:温州医科大学,2011.
[25] 严瑞红,赵亮,卢宏柱.川崎病患儿血清细胞因子水平及与冠状动脉损伤的关系[J].中国妇幼保健,2020,35(14):2611-2614.
[26] SHIMIZU M,MIZUTA M,USAMI M,et al.Clinical significance of serum soluble TNF receptor Ⅱ level and soluble TNF receptor Ⅱ/Ⅰ ratio as indicators of coronary artery lesion development in Kawasaki disease[J].Cytokine,2018,108:168-172.

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备注/Memo

备注/Memo:
[基金项目]陕西省重点研发计划项目(S2022-YF-YBSF-1204,2017ZDCXL-SF-02-04-02)
更新日期/Last Update: 2025-03-05