川崎病患儿治疗前后血清抵抗素和内脂素的变化

Changes in serum levels of resistin and visfatin in pediatric patients with acute Kawasaki disease following intravenous immune globulin treatment

摘要:

目的 检测急性期川崎病（KD）患儿静脉注射丙种球蛋白（IVIG）治疗前后血清中抵抗素和内脂素含量的变化及意义。方法 选择2011年1月至2013年1月确诊的KD患儿50例为研究对象，同时选取30例健康儿童和30例急性感染性疾病患儿作为对照。酶联免疫吸附法检测KD患儿IVIG治疗前后及对照儿童血清中抵抗素和内脂素的水平。结果 KD患儿血清抵抗素和内脂素含量均明显高于健康对照组和急性感染性疾病患儿（均P<0.05）；经过48 h治疗后，IVIG治疗有效KD患儿血清抵抗素含量较治疗前明显降低（P<0.05），内脂素含量在IVIG治疗有效KD患儿治疗前后差异无统计学意义（P >0.05）；IVIG治疗无效KD患儿（n=12）治疗前血清抵抗素水平明显高于IVIG治疗有效组（n=38，P<0.05），而内脂素含量在两组患儿治疗前差异无统计学意义（P >0.05）；KD合并冠脉损害与非冠脉损害患儿的抵抗素和内脂素水平差异均无统计学意义（P >0.05）。结论 KD患儿血清中高表达的抵抗素和内脂素可能参与了KD的发生和发展；血清抵抗素含量可能成为临床观察IVIG治疗效果的新监测指标。

Abstract:

Objective To determine serum levels of resistin and visfatin in the patients with acute Kawasaki disease before and after intravenous immune globulin (IVIG) treatment. Methods A total of 50 children with acute Kawasaki disease were treated with IVIG for 48 hours between January 2011 and January 2013. As controls, 30 healthy children and 30 children with acute infectious diseases were included. Serum levels of resistin and visfatin were measured by ELISA both before and after the treatment. Results The baseline serum levels of resistin and visfatin were significantly higher in patients with acute Kawasaki disease than in the two control groups of subjects (i.e., healthy children and patients with acute infectious diseases; P<0.05). In the 50 patients with Kawasaki disease, 38 were not responding and 12 were responding. Serum resistin levels before treatment were significantly higher in non-responders than those in responders (P<0.05). A significant decrease in serum levels of resistin after treatment was observed in IVIG responders (P<0.05). Serum visfatin levels were not significantly different between IVIG responders and non-responders (P >0.05). Additionally, serum resistin and visfatin levels were not significantly different between acute Kawasaki disease patients with and without coronary artery lesions. Conclusions Resistin and visfatin may play important roles in the development of Kawasaki disease and serum resistin may be used as a novel outcome indicator of the IVIG treatment.