TNF-α is superior to conventional inflammatory mediators in forecasting IVIG nonresponse and coronary arteritis in Chinese children with Kawasaki disease
TNF-α is superior to conventional inflammatory mediators in forecasting IVIG nonresponse and coronary arteritis in Chinese children with Kawasaki disease
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DOI：
10.1016/j.cca.2017.05.019
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发表时间：
2017-08-01
影响因子：
5
通讯作者：
Hu, Bo
中科院分区：
文献类型：
--
作者：
Hu, Peng;Jiang, Guang Mei;Hu, Bo
背景资料：肿瘤坏死因子（TNF）-α是主要由活化的单核细胞/巨噬细胞产生的炎症细胞因子，与川崎病（KD）的发病机制有关。方法：70例KD患儿分为6个亚组，即完全型KD、不完全型KD、静脉注射免疫球蛋白（WIG）反应型KD、静脉注射免疫球蛋白（IVIG）无反应型KD、冠状动脉（CA）无受累型KD和CA受累型KD。分别在WIG治疗前24 h和治疗后48 h采集所有受试者的血液样品。结果：TNF-α在川崎病急性期明显升高，与CRP、PCT呈正相关，治疗后TNF-α仍维持在较高水平。TNF-α和常规炎症介质不能用于区分KD的临床分类，但它们可能有助于提高或降低对不完全KD的怀疑。IVIG无反应患者和冠状动脉炎患者的血浆TNF-α显著升高，但在所有其他炎症介质中未观察到显著差异。结论：TNF-α在预测川崎病患儿IVIG无反应和冠状动脉炎方面优于传统炎症介质，具有上级预测价值。
Background: Tumor necrosis factor (TNF)-alpha is of inflammatory cytokines produced chiefly by activated monocyte/macrophages, and has been implicated in the pathogenesis of Kawasaki disease (KD). We elucidated the relationship of plasma TNF-alpha with conventional inflammatory mediators, clinical classification, intravenous immunoglobulin (WIG) response and coronary arteritis in the course of KD.Methods: Seventy Chinese children with KD were enrolled and divided into 6 subgroups, including complete KD, incomplete KD, WIG-responsive KD, IVIG-nonresponsive KD, coronary artery (CA)-noninvolvement KD and CA involvement KD. Blood samples were collected from all subjects at 24 h pre-and 48 h post-WIG therapy, respectively. TNF-alpha, white blood cells counts (WBC), absolute neutrophil counts (ANC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin (PCT) were detected.Results: Plasma TNF-alpha markedly increased in the-acute phase of KD and was positively correlated with CRP and PCT, whereas remained high after WIG therapy. TNF-alpha as well as conventional inflammatory mediators could not be used to differentiate the clinical classification of KD, but they may prove beneficial to heighten or reduce the suspicion of incomplete KD. Plasma TNF-alpha was significantly higher in both IVIG-nonresponsive patients and coronary arteritis patients, but no significant differences were observed in all the other inflammatory mediators. Moreover, plasma TNF-alpha was positively correlated with the internal diameter of CA.Conclusions: TNF-alpha is superior to conventional inflammatory mediators in forecasting IVIG nonresponse and coronary arteritis in Chinese children with KD.