IVIG无反应性川崎病预测指标的探讨及CaSR与川崎病的关系

发布时间：2018-04-08 09:20

本文选题：川崎病　切入点：静脉丙种球蛋白　出处：《天津医科大学》2017年硕士论文

【摘要】：目的通过对102例川崎病患儿临床资料进行回顾性分析,探索IVIG无反应性川崎病的预测指标,并通过统计学分析得到相应的诊断界值;通过实验室研究探讨CaSR与川崎病的关系。进一步阐明川崎病发病机制,为川崎病诊断治疗提供新思路。方法1.选取2012年1月至2016年1月在天津医科大学总医院初诊且临床资料完整的102例KD患儿。其中男孩64例,女孩38例,年龄分布在3个月~8岁。入院后,所有患儿都给予IVIG治疗,根据对治疗是否敏感,分为IVIG敏感组和IVIG无反应组。对其一般资料、临床特征、实验室检查、辅助检查等临床资料进行回顾性研究及统计学分析,探寻预测IVIG无反应性川崎病的特异性指标。2.选择2015年1月至2017年1月于我院儿科病房治疗的KD患儿40例做为实验组进行实验室数据研究,其中男孩25例,女孩15例,平均年龄为1.95±1.69岁。另选取25例查体健康的儿童做为对照组,其中男孩15人,女孩10人,平均年龄为1.85±1.71岁。在应用IVIG治疗前,采用蛋白免疫印迹(Western Blot)技术,检测两组研究对象外周血淋巴细胞中CaSR的表达情况;在应用IVIG治疗后,再次检测KD组患儿CaSR表达情况。结果1.IVIG无反应组KD患儿血浆NT-proBNP及CRP水平明显高于IVIG敏感组,且为IVIG无反应性KD发生的独立危险因素。ROC曲线分析表明当川崎病患儿血浆NT-proBNP浓度大于746.3ng/L时,发生IVIG无反应的可能性大,灵敏度为0.917,特异度为0.674;当CRP浓度大于100mg/L时,发生IVIG无反应的可能性大,灵敏度=0.667,特异度=0.800;2.本研究通过实验证实了IVIG治疗前川崎病患儿外周血淋巴细胞确有CaSR的表达,有望而对照组CaSR不表达或表达量极少;IVIG治疗后,CaSR表达显著下降。结论1.血浆NT-proBNP及CRP水平升高作为预测川崎病患儿对丙种球蛋白是否敏感的特异性指标有一定意义,但均存在局限性。2.川崎病患儿外周血淋巴细胞中确有CaSR的表达,为后续研究奠定基础,未来CaSR有望作为川崎病预测、诊断及治疗的特异性指标,从而进一步阐明川崎病发病机制,为川崎病治疗提供新思路。
[Abstract]:Objective to analyze the clinical data of 102 children with Kawasaki disease (Kawasaki disease), to explore the predictive index of IVIG nonreactive Kawasaki disease, and to obtain the corresponding diagnostic bounds by statistical analysis, and to explore the relationship between CaSR and Kawasaki disease by laboratory study.To further elucidate the pathogenesis of Kawasaki disease and provide a new idea for the diagnosis and treatment of Kawasaki disease.Method 1.102 children with KD were selected from January 2012 to January 2016 in Tianjin Medical University General Hospital.There were 64 boys and 38 girls, aged from 3 months to 8 years old.After admission, all children were treated with IVIG. According to the sensitivity of treatment, they were divided into IVIG sensitive group and IVIG nonreactive group.The general data, clinical characteristics, laboratory examination, auxiliary examination and other clinical data were analyzed retrospectively and statistically to find the specific index of predicting IVIG non-reactive Kawasaki disease. 2.From January 2015 to January 2017, 40 children with KD were selected as experimental group, 25 boys and 15 girls, with an average age of 1.95 卤1.69 years.Another 25 healthy children were selected as control group, including 15 boys and 10 girls, with an average age of 1.85 卤1.71 years.Before IVIG treatment, the expression of CaSR in peripheral blood lymphocytes was detected by Western blotting technique, and the expression of CaSR in KD group was detected again after IVIG treatment.Results the plasma levels of NT-proBNP and CRP in KD patients without 1.IVIG were significantly higher than those in IVIG sensitive children, and the plasma NT-proBNP levels in Kawasaki disease children were higher than those in Kawasaki disease patients, which was an independent risk factor for the occurrence of IVIG non-reactive KD.When the concentration of CRP was higher than that of 100mg/L, the possibility of no reaction of IVIG was high, the sensitivity was 0.667, and the specificity was 0.800 ~ 2 ~ (2), the sensitivity was 0.917 and the specificity was 0.674.When the concentration of CRP was higher than that of 100mg/L, the possibility of no reaction of IVIG was high.This study confirmed that the expression of CaSR in peripheral blood lymphocytes of children with Kawasaki disease before treatment with IVIG was confirmed. It is hopeful that the expression of CaSR in the control group is not expressed or is very small. The expression of CaSR in children with Kawasaki disease was significantly decreased after IVIG treatment.Conclusion 1.The increase of plasma NT-proBNP and CRP levels is a specific index to predict the sensitivity of serum gamma globulin to Kawasaki disease in children with Kawasaki disease.There is CaSR expression in peripheral blood lymphocytes of children with Kawasaki disease, which will lay a foundation for further study. In the future, CaSR may be used as a specific index for the prediction, diagnosis and treatment of Kawasaki disease, thus further elucidating the pathogenesis of Kawasaki disease.To provide a new idea for the treatment of Kawasaki disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4

【参考文献】