摘要
目的 研究免疫水平和炎症因子检测在川崎病与幼年型特发性关节炎(JIA)鉴别诊断中的临床意义.方法 回顾性选取2020年6月至2023年6月入大庆龙南医院的30例川崎病患儿、30例JIA患儿及30名健康体检儿童,依次设为川崎病组、JIA组和健康组.测定并比较3组儿童血清体液免疫指标[免疫球蛋白(Ig)M、IgA、IgG、补体C4(C4)、补体 C3(C3)]、细胞免疫指标(CD4+/CD8+、CD19+B 细胞、CD16+CD56+NK 细胞、CD8+T 细胞、CD4+T 细胞、CD3+T细胞)、炎症因子[肿瘤坏死因子-α(TNF-α)、可溶性白细胞介素-2受体(sIL-2R)、白细胞介素(IL)-6、IL-10]、外周血常规指标[C反应蛋白(CRP)、血小板(PLT)计数、血红蛋白、白细胞(WBC)计数].采用Logistic回归分析及受试者工作特征(ROC)曲线分析各指标对川崎病、JIA的鉴别诊断效能.结果 (1)3组儿童血清IgM水平比较,差异无统计学意义(P＞0.05);较健康组,川崎病组、JIA组患儿IgA、IgG、C4、C3水平均更高,差异均有统计学意义(P＜0.05);较JIA组,川崎病组IgG、C4、C3水平均更高,差异均有统计学意义(P＜0.05).(2)较健康组,川崎病组、JIA组患儿的CD16+CD56+NK细胞水平更低,CD4+T、CD3+T细胞水平更高,差异均有统计学意义(P＜0.05);较JIA组,川崎病组患儿的CD4+/CD8+比值、CD19+B细胞水平更高,CD16+CD56+NK、CD8+T细胞、CD3+T细胞水平更低,差异均有统计学意义(P＜0.05).(3)较健康组,川崎病组、JIA组患儿TNF-α、sIL-2R、IL-6、IL-10水平均更高,差异均有统计学意义(P＜0.05);较JIA组,川崎病组患儿的TNF-α、sIL-2R、IL-10水平均更高,IL-10水平更低,差异均有统计学意义(P＜0.05).(4)较健康组,川崎病组、JIA组患儿CRP水平、WBC计数均更高,川崎病组血红蛋白水平更低,PLT计数更高,差异均有统计学意义(P＜0.05);较JIA组,川崎病组患儿的CRP水平、PLT计数更高,血红蛋白水平更低,差异均有统计学意义(P＜0.05).(5)多因素Logistic回归分析及ROC曲线分析结果显示,C3为川崎病、JIA鉴别诊断最佳单项免疫学指标,ROC曲线下面积为0.849,多指标联合检测曲线下面积为0.953.结论 免疫水平、炎症因子检测可为川崎病、JIA鉴别诊断提供参考依据,通过检测免疫学指标有益于了解川崎病、JIA患儿免疫特征的异同,且以C3为川崎病、JIA鉴别诊断最佳单项免疫学指标,多项免疫指标联合检测可提升诊断准确性.
Abstract
Objective To investigate the significance of detection of immune levels and inflammatory factors in differential diagnosis of Kawasaki disease and juvenile idiopathic arthritis(JIA).Methods Thirty children with Kawasaki disease,30 children with JIA and 30 healthy children admitted to Daqing Longnan Hospital from June 2020 to June 2023 were retrospectively selected as Kawasaki disease group,JIA group and healthy group.The three groups of humoral immune indexes[immunoglobulin(Ig)M,IgA,IgG,complement C4(C4),complement C3(C3)],cellular immune indexes(CD4+/CD8+ratio,CD19+B cells,CD 16+CD56+NK cells,CD8+T cells,CD4+T cells,CD3+T cells),inflamma-tory factors[tumor necrosis factor-α(TNF-α),soluble interleukin-2 receptor(sIL-2R),interleukin(IL)-6,IL-10],peripheral blood routine indicators[C-reactive protein(CRP),platelet count(PLT),hemoglobin,white blood cell count(WBC)]were measured and com-pared.The differential diagnostic efficacy of each index for Kawasaki disease and JIA were analyzed using Logistic regression analysis and receiver operating characteristic(ROC)curve.Results(1)There was no significant difference in serum IgM level among the three groups(P＞0.05).The levels of IgA,IgG,C4 and C3 in the healthy group,Kawasaki disease group and JIA group were higher than those in the healthy group,Ka-wasaki disease group and JIA group,the differences were statistically significant(P＜0.05).Compared with the JIA group,the levels of IgG,C4 and C3 in the Kawasaki disease group were higher,and the differences were statistically significant(P＜0.05).(2)Compared with the healthy group,Kawasaki disease group and JIA group,the level of CD16+CD56+NK cells was lower,and the levels of CD4+T and CD3+T cells were higher,the differences were statistically significant(P＜0.05).Compared with the JIA group,the CD4+/CD8+ratio and the level of CD19+B cells in the Kawasaki disease group were higher,and the levels of CD16+CD56+NK,CD8+T cells and CD3+T cells were lower,the differences were statistically significant(P＜0.05).(3)The levels of TNF-α,sIL-2R,IL-6 and IL-10 in the healthy group,Kawasaki disease group and JIA group were higher than those in the healthy group,Kawasaki disease group and JIA group,and the differences were statisti-cally significant(P＜0.05).Compared with the JIA group,the levels of TNF-α,sIL-2 R and IL-10 in the Kawasaki disease group were higher,and the level of IL-10 was lower,the differences were statistically significant(P＜0.05).(4)Compared with the healthy group,the CRP level and WBC count in the Kawasaki disease group and the JIA group were higher,the hemoglobin level in the Kawasaki disease group was lower,and the PLT count was higher,the differences were statistically significant(P＜0.05);compared with the JIA group,the CRP level and PLT count in the Kawasaki disease group were higher,and the hemoglobin level was lower,the differences were statistically significant(P＜0.05).(5)Multivariate Logistic regression analysis and ROC curve analysis showed that C3 was the best single immunological index for differenti-al diagnosis of Kawasaki disease and JIA.The area under the ROC curve was 0.849,and the area under the multi-index combined detection curve was 0.953.Conclusion The detection of immune level and inflammatory factors can provide reference for the differential diagnosis of Ka-wasaki disease and JIA.The detection of immunological indexes is helpful to understand the similarities and differences of immune characteristics between children with Kawasaki disease and JIA.C3 is the best single immunological index for the differential diagnosis of Kawasaki disease and JIA.The combined detection of multiple immune indexes can improve the diagnostic accuracy.
维普
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