肝素对川崎病炎性细胞因子及组织因子途径抑制物影响的研究

摘要

目的 观察不同的治疗方案下川崎病(KD)患儿治疗前和治疗后各阶段血浆白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、组织因子途径抑制物(TFPI)的变化,分析肝素对各指标的影响,探讨其作用机制.方法 2009年1月至2010年12月我院住院治疗的KD患儿56例.将住院KD患儿随机分为肝素治疗组和常规治疗组,并与健康体检儿童作对照.采用酶联免疫吸附法(E LISA)检测治疗前和治疗后各阶段患儿血浆IL-6、TNF-α和TFPI.结果 KD患儿治疗前血浆IL-6、TNF-α、TFPI较正常对照组儿童显著升高,差异有统计学意义(P＜0.05)；治疗后5～7d、2～3周、2～3月血浆IL-6、TNF-α显著降低,TFPI显著升高.其中治疗后5～7d,肝素治疗组血浆IL-6、TNF-α较常规治疗组下降显著(8.059:±3.658 pg/ml vs 17.218±10.215 pg/ml,33.72±18.34 pg/ml vs 67.85±32.78 pg/ml)；TFPI升高显著(50.367±10.246 vs 43.787±7.0594),可持续到2～3月(41.048±6.215 pg/ml vs 29.885±7.259 pg/ml),差异有统计学意义(P＜0.05).结论 川崎病患儿急性期血浆IL-6、TNF-α、TFPI水平增高,肝素可通过进一步提高TFPI而降低IL-6、TNF-α水平,且TFPI升高持续时间较长,从而起到抗炎抗凝双重作用,减轻冠状动脉损害,减少血栓发生的风险.%Objective To study the levels of serous IL-6,TNF-a and TFPI in different treatment for patient with Kawasaki disease (KD). And to investigate the mechanism of heparin in KD. Methods 56 patients with KD and twenty healthy children as control were recruited into the study. The patients with KD were randomly divided into two groups: heparin treatment group and conventional treatment group. The plasma IL-6,TNF-a and TFPI levels were detected by ELISE Methods. Results The levels of plasma IL-6,TNF-a were significantly increased in patients with KD before treatment compared with the healthy control group. After treatment for five to seven days,two to 3 weeks and 2 ~3 months,IL-6 ,TNF-a levels were significantly decreased , while TFPI leVels was significantly increased. After treatment for 5 ~ 7 days, the levels of plasma IL-6,TNF-a were significantly decreased in the heparin treatment group than those in the conventional treatment group(8.059 +3.658 pg/ml vs 17.218 ?10.215 pg/ml,33.72 + 18.34 pg/ml vs 67.85 +32.78 pg/ml,P < 0. 05), the level of TFPI was significantly increased in the heparin treatment group than that in the conventional treatment group(50.367 +10.246 pg/ml vs 43. 787 +7. 0594 pg/ml,P <0. 05). Which can last two to three months (41.048 +6.215 pg/ml vs29. 885 +7.259 pg/ml) ,the different is statistic significant. (P<0. 05 ). Conclusion The plasma levels of IL-6 ,TNF-ot and TFPI advance at acute phase in KD ,and TFPI lasts a quite long time. Heparin could decrease the plasma levels of IL-6,TNF-a by increasing TFPI to educe dual effects of anti-inflammatory and anticoagulation, eventually, diminished the damage of immune vasculitis and reduce the hypercoagulability in KD .