目的 探讨血清白细胞介素-17A（interleukin-17A，IL-17A）在静脉注射免疫球蛋白（intravenous immunoglobulin，IVIG）无反应型川崎病（Kawasaki disease，KD）患儿中表达的特点及其临床意义。 方法 前瞻性纳入2021年6月—2022年6月于华中科技大学同济医学院附属武汉儿童医院住院的KD患儿143例为研究对象，其中IVIG敏感型115例，IVIG无反应型28例。另选取110例同性别、同年龄段急性呼吸道感染性疾病患儿（发热时间≥5 d，但排除了KD）作为对照组。采用酶联免疫吸附分析检测血清IL-17A水平，同时检测全血白细胞计数（white blood count，WBC）、中性粒细胞计数（neutrophil count，NE）、血小板计数（platelet count，PLT）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、C反应蛋白（C-reactive protein，CRP）水平。绘制受试者工作特征曲线分析WBC、NE、CRP及IL-17A对IVIG无反应型KD的预测价值。采用多因素logistic回归模型分析KD患儿IVIG无反应的预测因素。 结果 IVIG治疗前，KD组患儿血清IL-17A水平明显高于对照组（P<0.05），IVIG无反应型KD患儿血清IL-17A水平明显高于敏感型KD患儿（P<0.05）。受试者工作特征曲线分析显示，WBC、NE、CRP、IL-17A预测IVIG无反应型KD的曲线下面积分别为0.718、0.741、0.627、0.840。以血清IL-17A≥44.06 pg/mL为截断值，IL-17A预测IVIG无反应型KD的灵敏度、特异度分别为84%、81%。多因素logistic回归分析显示高水平血清IL-17A表达为KD患儿IVIG无反应的预测因素（OR=1.161，P=0.001）。 结论 血清IL-17A水平在无反应型KD患儿中增高；血清IL-17A水平（≥44.06 pg/mL）对无反应型KD具有预测价值。
Abstract
Objective To study the expression of interleukin-17A (IL-17A) in the serum of children with intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) and its clinical significance. Methods A total of 143 children with KD who were hospitalized in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, from June 2021 to June 2022 were enrolled in this prospective study, among whom 115 had IVIG-sensitive KD and 28 had IVIG-resistant KD. After matching for sex and age, 110 children with acute respiratory infectious diseases (fever time ≥5 days but without KD) were enrolled as the control group. The enzyme-linked immunosorbent assay was used to measure the serum level of IL-17A. The levels of white blood cell count (WBC), neutrophil count (NE), platelet count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were measured. The receiver operating characteristic curve was plotted to analyze the value of WBC, NE, CRP, and IL-17A in the prediction of IVIG-resistant KD. The multivariate logistic regression analysis was used to evaluate the predictive factors for resistance to IVIG in children with KD. Results Before IVIG treatment, the KD group had a significantly higher serum level of IL-17A than the control group (P<0.05), and the children with IVIG-resistant KD had a significantly higher serum level of IL-17A than those with IVIG-sensitive KD (P<0.05). The receiver operating characteristic curve analysis showed that WBC, NE, CRP, and IL-17A had an area under the curve of 0.718, 0.741, 0.627, and 0.840, respectively, in the prediction of IVIG-resistant KD. With serum IL-17A ≥44.06 pg/mL as the cut-off value, IL-17A had a sensitivity of 84% and a specificity of 81% in the prediction of IVIG-resistant KD. The multivariate logistic regression analysis showed that a high serum level of IL-17A was a predictive factor for resistance to IVIG in children with KD (OR=1.161, P=0.001). Conclusions Serum IL-17A levels are elevated in children with IVIG-resistant KD, and serum IL-17A level (≥44.06 pg/mL) may have a predictive value for resistance to IVIG in children with KD.
关键词
川崎病 /
静脉注射丙种球蛋白无反应 /
白细胞介素-17A /
儿童
Key words
Kawasaki disease /
Resistance to intravenous immunoglobulin /
Interleukin-17A /
Child
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