Tumor necrosis factor receptor during acute Kawasaki disease

为了评估肿瘤坏死因子α (tnf - α)在急性川崎病中的作用，我们测量了48例急性川崎病患者p60可溶性肿瘤坏死因子受体（sTNF-R）在循环中的脱落，所有患者均接受静脉输注γ -球蛋白。48例患者中，5例有冠状动脉病变。采用夹心酶免疫分析法测定血清p60 sTNF-R和tnf - α浓度。川崎病患者血清p60 sTNF-R水平升高。我们发现急性川崎病患者血清p60 sTNF-R水平与TNFalpha水平呈正相关。此外，冠状动脉病变患者的sTNF-R水平高于无冠状动脉病变患者。我们的研究结果表明，血清中p60 sTNF-R水平可能有助于确定急性川崎病期间血管损伤的严重程度，并且川崎病患者和高sTNF-R水平似乎容易发生冠状动脉病变，即使他们接受静脉输注γ -球蛋白治疗。接下来，我们用磁性细胞分离器（MACS）采集5例川崎病急性期患者外周血CD14_+单核细胞，并用电镜观察。MACS是一种可以分离和选择特定单元格的机器。在川崎病患者中观察到一种在正常单核细胞中看不到的形式。川崎病急性期细胞质内可见核仁，细胞核形态更为复杂，胞质内可见大量颗粒。我们推测，细胞活化（如细胞因子的产生，特别是TNFalpha）与外周血CD14_+单核细胞的变化之间可能存在某种关系。

To evaluate the role of tumor necrosis factor alpha (TNF-alpha) during acute Kawasaki disease, we measured p60 soluble tumor necrosis factor receptor (sTNF-R) shedding into the circulation in 48 patients with acute Kawasaki disease, all of whom received intravenous infusions of gamma-globulin. Of the 48 patients, 5 had coronary artery lesions. Serum concentrations of p60 sTNF-R and TNF-alpha were measured by a sandwich enzyme immunoassay. Patients with Kawasaki disease had increased serum levels of p60 sTNF-R.We found a positive correlation between serum levels of p60 sTNF-R and levels of TNFalpha during acute Kawasaki disease. Moreover, patients with coronary artery lesions had higher levels of sTNF-R than did those without coronary artery lesions. Our findings indicate that p60 sTNF-R levels in serum may be useful for determining the severity of vascular damage during acute Kawasaki disease, and that patients with Kawasaki disease and high sTNF-R levels seem to be susceptible to coronary artery lesions even if they receive therapy with intravenous infusions of gamma-globulin.Next, we gathered peripheral blood CD14_+ monocytes through magnetic cell separator (MACS) and examined them using an elctron microscope in 5 patients with Kawasaki disease during the acute stage. MACS is a machine that can separate and select specific cells. A form that cannot be seen in normal monocytes was observed in patients with Kawasaki disease. Nucleoli were seen and the form of the nuclei was more complex and in addition, a large quantity of granules was seen in the cytoplasm during acute Kawasaki disease. It is our speculation that a relation may exist between cell activation such as the production of cytokines, in particular TNFalpha and those changes seen in the peripheral blood CD14_+ monocytes.