川崎病休克综合征临床特征及外周血细胞因子水平分析

摘要

Objective To investigate the clinical characteristics and serum cytokine levels in children with Kawasaki disease shock syndrome (KDSS).Methods Seventeen KDSS children and 43 age-and gender-matched patients with Kawasaki disease (KD) admitted during January 2014 to December 2016 were included in this study.Serum levels of interleukin-2(IL-2),IL-4,IL-6,IL-10,tumor necrosis factor-α (TNF-α),and interferon gamma (IFN-γ) were measured by flow cytometry in two groups.The clinical characteristics,serum cytokine levels and routine laboratory parameters,the liver,kidney and blood coagulation functions and disease outcomes were compared between two groups.Results Compared with KD group,the duration of fever and length of hospital stay in KDSS group were significantly prolonged,the WBC,neutrophil,ESR and serum CRP,creatinine,urea nitrogen,D-dimer,IL-6,IL-10,TNF-α IFN-γ.levels were elevated,the incidence of coronary artery lesions,intravenous immunoglobulin (IVIG) resistance,admission to ICU and other organ damage were significantly increased (all P＜0.05),while blood hemoglobin,albumin,sodium and potassium concentrations were significantly decreased (all P＜0.05).No deaths were found in two groups.Conclusion Increased levels of IL-6,IL-10,TNF-oα,IFN-γ and IVIG resistance leading to persistent inflammation may be involved in the development of KDSS.The duration of fever and hospital stay are prolonged,the conditions are more serious and more susceptible to coronary and other organ damage in patients with KDSS.%目的 分析川崎病休克综合征(KDSS)的临床特征及外周血细胞因子水平,为该病的诊治提供依据.方法 选择KDSS患儿17例(KDSS组),并选择同期住院且年龄、性别匹配的川崎病[KD)患儿43例(KD组).采用流式细胞术检测两组患儿外周血细胞因子IL-2、IL-4、IL-6、IL-10、TNF-α和IFN-y水平,并比较两组患儿确诊前的临床特征、常规实验室指标、肝肾功能及凝血功能指标、疗效及预后情况.结果 与KD组比较,KDSS组发热时间和住院时间显著延长,外周血WBC、中性粒细胞比例、C反应蛋白、ESR、肌酐、血尿素氮、D-二聚体,IL-6、IL-10、TNF-α、IFN-y水平,冠状动脉损伤、丙种球蛋白(IVIG)抵抗、进重症监护室及其他脏器损伤的发生率均显著升高,而Hb、血钠、血钾、白蛋白均显著下降,差异均有统计学意义(均P＜0.05).两组均未发现死亡病例.结论 细胞因子IL-6、1L-10、TNF-α和IFN-y水平的升高、IVlG抵抗导致持续炎症可能参与KDSS的发生,KDSS患儿发热时间和住院时间显著延长,病情更重,更易发生冠状动脉及其他脏器损伤.