人白介素18基因启动子多态性与儿童1型糖尿病的相关性研究

目的研究IL-18基因单核苷酸多态性与儿童1型糖尿病（T1DM）的关系。方法应用聚合酶链反应．序列特异性引物（PCR-SSP）和测序的方法，检测118例1型糖尿病患儿和150例正常儿童IL-18基因．137位点C／G和-607位点C／A单核苷酸的多态性。结果①IL-18基因-607位点C／A的-607A等位基因在T1DM和对照组中的发生率分别为41％和53％，差异有统计学意义（P=0．01），两组间．137位点C／G的等位基因差异无统计学意义（P=0．37）；②IL-18基因．137位点的CC、CG和GG基因型在T1DM和对照组中差异均无统计学意义（P〉0．05）；-607位点的CC基因型T1DM组显著高于正常对照组（P=0．03），AA基因型T1DM组显著低于正常对照组（P=0．03）；IL-18基因-607位点的CC基因型的新发糖尿病患儿更易发生酮症酸中毒。③IL-18基因的-137G／-607C单体基因型在T1DM和正常对照组间的分布频率差异有统计学意义（P=0．03）。结论IL-18基因-607位点的CC基因型和-137G／-607C单体基因型可能与儿童1型糖尿病的发病有关，而-607位点的AA基因型可能是T1DM的保护性基因型。-607位点的CC基因型与儿童1型糖尿病患者临床表型存在显著的相关性。     

白细胞介素-6基因-572C/G多态性与全身炎症反应综合征的相关性

目的 探讨IL-6基因-572C/G多态性与小儿全身炎症反应综合征(SIRS)的关系.方法 选用病例-对照的研究方法,以本院53例SIRS患儿为SIRS组,并随机挑选50例健康儿童为健康对照组(所有儿童均为汉族,来自广东省深圳市),采用酚/氯仿法提取2组儿童外周血白细胞DNA,并制备血清.自行设计引物,应用聚合酶链反应对2组研究对象的IL-6基因启动子-572位点的特异性片段进行扩增,再应用限制性片段长度多态性法对扩增的特异性片段用限制性内切酶进行酶切.酶切产物采用琼脂糖凝胶电泳法进行检测,分析2组儿童IL-6基因-572位点基因型及等位基因频率的分布.应用酶联免疫吸附法(ELISA)检测2组儿童血清IL-6水平,观察不同基因型对其血清IL-6水平的影响.采用SPSS 13.0软件进行数据分析.结果 IL-6基因-572位点基因型和等位基因频率在2组间分布差异均有统计学意义(Pa＜0.05);SIRS组GG基因型和G等位基因频率均显著高于健康对照组(Pa＜0.05);携带G等位基因个体患SIRS的风险约是C等位基因型个体的5.91倍(95% CI为2.76～12.64);SIRS组血清IL-6水平显著高于健康对照组(P＜0.05);G等位基因携带者血清IL-6水平显著高于CC基因携带者(P＜0.05).结论 IL-6基因-572C/G多态性与中国汉族儿童SIRS发病密切相关;血清IL-6水平可能受其基因多态性的影响.     

小儿急性阑尾炎手术前后sICAM-1、IL-8和TNFa的变化及其临床意义

目的探讨急性阑尾炎患儿血清可溶性细胞间粘附分子-1（sICAM-1）、白细胞介素-8（IL-8）和肿瘤坏死因子-a（TNFa）的变化及临床意义。方法应用酶联免疫吸附测定法检测70例急性阑尾炎患儿不同时间（术前、术后7d）血清中sICAM-1、IL-8和TNFa的含量水平。结果各组术前血清sICAM-1、IL-8、TNFa的水平明显高于对照组（P〈0．01）；化脓性、坏疽穿孔性阑尾炎组血清sICAM-1与IL-8、TNFa变化呈正相关（P〈0．05）；单纯组外周血白细胞（WBC）与sICAM-1呈正相关（P〈0．05）；8例并发症血清sICAM-1与IL-8、TNFa升高明显。结论血清sICAM-1、IL-8和TNFa在小儿急性阑尾炎的发病中起着重要的作用，检测其变化对小儿急性阑尾炎的诊断、病程监测和预后估计具有一定的临床价值。     

IL-6 C-572G多态性位点与自发性早产遗传易感性的关系

目的探讨IL-6基因C-572G多态性位点与自发性早产(SPTB)遗传易感性的关联性。方法研究对象来自北京及其周边地区。病例组包括569例SPTB新生儿,其中超早产儿(胎龄28周)56例、极早产儿(胎龄28~31~(+6)周)166例和中晚期早产儿(胎龄32~36~(+6)周)347例。对照组包括673例足月新生儿。采用最新的Sequenom Mass ARRAY~?SNP检测技术对IL-6基因C-572G位点进行单核苷酸多态性分型。结果与携带IL-6基因C-572G位点的CC基因型的个体相比,携带至少1个G等位基因型(CG+GG基因型)的个体发生中晚期SPTB的风险显著升高(OR=1.35,95%CI:1.01~1.80,P=0.04)。结论在该中国人群中,IL-6基因C-572G多态性位点与中晚期SPTB患病风险的增加存在显著的遗传学关联。     

白细胞介素-6基因多态性与热性惊厥相关性研究

目的 探讨白细胞介素(IL)-6基因启动子多态性与不同类型热性惊厥的相关关系.方法 本研究对单纯热性惊厥164例、复杂热性惊厥35例、热性惊厥继发无热惊厥26例患儿及同期对照组180例患儿采血直接基因测序,对IL-6基因启动子的-174、-572、-597位点的基因多态性进行比较分析.结果 各组患儿间IL-6基因-174位点基因型比较,差异无统计学意义(x2=1.809,P=0.613);热性惊厥组与对照组-174位点等位基因频率比较,差异无统计学意义(x2=0.039,P=0.844).各组患儿间IL-6基因-572位点基因型比较,差异无统计学意义(x2=6.484,P=0.371);热性惊厥组与对照组-572位点等位基因频率比较,差异无统计学意义(x2=0.262,P=0.609).各组患儿间IL-6基因-597位点基因型比较,差异无统计学意义(x2=2.675,P=0.445);热性惊厥组与对照组-597位点等位基因频率比较,差异无统计学意义(x2=0.050,P=0.824).结论 IL-6启动子基因多态性与热性惊厥并无明确相关关系.     

支气管哮喘患儿诱导痰液中白细胞介素-4及γ-干扰素水平的研究

目的研究支气管哮喘患儿诱导痰液中白细胞介素（IL）-4及γ-干扰素（IFN-γ）水平变化，探讨其在哮喘发病机制中的作用。方法2004年2月～2006年6月儿科住院哮喘患儿36例，用ELISA法测定诱导痰中急性期及缓解期IL-4及IFN-γ水平。结果哮喘患儿诱导痰IL-4水平急性期明显高于缓解期和正常对照组（P〈0．01）；IFN-γ水平急性期低于缓解期及对照组（P〈0．05）；IL-4／IFN-γ比值急性期高于缓解期及对照组（P〈0．05）。急性期患儿诱导痰IL-4水平重症组明显高于轻症组（P〈0．01），IFN-γ水平重症组明显低于轻症组（P〈0．05），IL-4／IFN-γ比值重症组高于轻症组（P〈0．05）。结论哮喘患儿存在Thl／Th2功能紊乱，IL-4及IFN-γ参与哮喘患儿的免疫状态改变，在哮喘发病机制中发挥一定作用。     

白细胞介素-10基因多态性与儿童肠道病毒71型感染的相关性研究

目的 探讨白细胞介素-10（IL-10）基因位点-1082A/G、-819C/T和-592C/A多态性与IL-10水平及儿童肠道病毒71型（EV71）感染程度的关系。方法 选取EV71感染的手足口病患儿137例为研究对象,其中轻症组91例,重症组46例,另选取行健康体检儿童122例为健康对照组,采集临床数据。采用酶联免疫吸附试验（ELISA）检测血清IL-10水平。采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）分析技术检测IL-10基因位点-1082A/G、-819C/T和-592C/A的多态性。结果 与健康对照组相比,EV71感染组患儿的-1082位点AA基因型频率和A等位基因频率更高（P < 0.05）。在EV71感染组中,重症组-1082位点AA基因型频率和A等位基因频率高于轻症组（P < 0.05）。两组间IL-10基因位点-819C/T和-592C/A多态性的分布比较差异均无统计学意义（P > 0.05）。重症组患儿血清IL-10水平明显高于轻症组和健康对照组（P < 0.05）。IL-10-1082 AA基因型、-819 TT基因型和-592 AA基因型与IL-10的低表达有关（P < 0.05）。在单倍型构建上,EV71感染组GCC单倍型的频率低于健康对照组（P < 0.05）。在EV71重症感染组中,ATA单倍型患儿的IL-10水平较其他单倍型显著降低,而GCC患儿的IL-10水平较其他单倍型显著升高（P < 0.05）;轻症组和健康对照组各单倍型间的IL-10水平比较差异无统计学意义（P > 0.05）。结论 IL-10基因多态性与IL-10表达水平及EV71感染严重程度有关。     

细胞炎前因子测定对感染性腹泻诊断的价值

目的 探讨细胞炎前因子水平变化对小儿急性感染性腹泻的意义。方法 采用酶联免疫吸附法（ELISA法）测定173例急性感染性腹泻患儿细胞炎前因子IL-6、TNF—α、IL-8水平，并与32名健康儿童对照组进行比较。结果 无论是细菌性肠炎还是病毒性肠炎，细胞炎前因子均高于对照组；且TNF—α在细菌组增高较病毒组增高明显，有显著差异（t=7．460P〈0．01）；IL-6在病毒感染时明显增高，其增高程度与细菌组比较有显著差异（t=2．073P〈0．05）；IL-8在细菌和病毒组均较对照组升高，但二者比较无显著差异（t=1．80P〉0．05）。结论 当临床不易鉴别小儿腹泻感染病原时，可借此检测来作辅助诊断，以指导临床医师选择正确的治疗方案。     

RANTES基因启动子区多态性对其蛋白表达的影响

目的 探讨调节正常T细胞表达和分泌活性因子（RANTES）基因启动子区单核苷酸多态性对其蛋白表达的影响。方法 分别测定44例正常儿童、44例哮喘患儿血清中及45例哮喘患儿外周血单个核细胞（PBMC）体外培养上清中RANTES的含量,同时对45例哮喘患儿DNA样本进行RANTES基因型确定。结果 哮喘患儿血清中RANTES的水平显著高于正常对照儿童（P〈0．01）。未发现RANTES-403（G／A）、-28（C／G）两位点的不同基因型显著影响哮喘患儿血清RANTES蛋白的水平（P〉0．05）,但两位点的不同基因型哮喘患儿,其PBMC分泌的RANTES水平有所不同：-403GA及-403AA基因型个体低于-403GG纯合型（P=0．06）,-28CG杂合型个体低于CC纯合型（P〈0．05）。结论 趋化因子RANTES在哮喘的发病中具有重要作用,RANTES基因启动子区单核甘酸多态性可能通过影响其基因的表达,进而影响蛋白的表达,最终影响哮喘的发病过程和严重程度。     

IL-17A基因多态性与儿童哮喘易感性的相关性研究

目的 探讨儿童IL-17A启动子区域（-197G/A和-692C/T）基因多态性与儿童哮喘易感性的关系,为能进一步寻找到哮喘的候选基因从而为患病高风险儿童早期预防奠定基础。方法 选取2013年8月至2015年8月门诊随访或住院的哮喘患儿65例为哮喘组,另选取同期行健康体检儿童70例为健康对照组,采集两组儿童外周静脉血,应用序列特异性引物聚合酶链反应（SSP-PCR）法检测IL-17A基因-197G/A和-692C/T两个位点的单核苷酸多态性（SNP）,统计分析两组间基因型及等位基因分布频率的差异。结果 IL-17A基因-692C/T位点哮喘组患儿TT基因型的分布频率（29%）显著高于健康对照组（16%）（P=0.012）;哮喘组-692T等位基因分布频率（52%）显著高于健康对照组（42%）（P=0.039）;罹患儿童哮喘的风险T等位基因携带者是C等位基因携带者的1.413倍（OR=1.413,95%CI：1.015~1.917）;而IL-17A基因-197G/A位点基因型及等位基因分布频率在哮喘组和健康对照组间比较差异无统计学意义（P > 0.05）。结论 IL-17A基因启动子区域-692C/T位点基因多态性与儿童哮喘的易感性相关,-692T等位基因携带者更易罹患儿童哮喘,而IL-17A-197G/A位点多态性与儿童哮喘的易感性无显著相关。     

The role of IL-6 572 C/G, 190 C/T,and 174 G/C gene polymorphisms in children’s obesity

The aim of this study was to establish the correlations between the polymorphisms of the genes interleukin (IL)-6 572, 190, and 174 in obese children. We assessed 222 hospitalized children divided into two groups: group I (control) included 110 patients with normal nutritional status, and group II consisted of 102 obesity patients. The two groups underwent IL-6 572 C/G, 190 C/T, and 174 G/C polymorphism testing, measurement of anthropometric parameters (mid-upper arm circumference and tricipital skinfold thickness), and paraclinical evaluation (protein, albumin, leptin, adiponectin, and vascular endothelial growth factor (VEGF)). We observed that phenotype CC was more frequent in obese children for IL-6 572 (p?=?0.0001), whereas CG heterozygotes were more frequent in the obese group for the IL-6 190 gene (62.7 %; p?=?0.0001). Leptin was dependent on IL-6 572 and IL-6 174 gene polymorphisms and albumin, whereas adiponectin was dependent on the IL-6 174 gene polymorphism. Body mass index (BMI), mid-upper arm circumference (MUAC), and tricipital skinfold thickness (TST) serum albumin levels correlated with C allele carriers of the IL-6 572 and IL-6 190 genes in children with obesity, whereas the CC genotype of IL-6 174 was a protective factor for obesity. Conclusion: Obesity is most frequently associated in children with IL-6 174 C allele carriers and with IL-6 190 C allele carriers.     

Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) levels and IL-6, TNF-polymorphisms in children with thrombosis

Infection has an important role in the pathogenesis of thrombosis and it becomes more prominent in childhood cases, in whom the infection frequency is higher. It has been suggested that patients with high tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 levels might be at increased risk of developing thrombotic complications owing to the effects of these cytokines on the coagulation pathway. Functional polymorphisms in the promoter regions of the genes coding for TNF-alpha and IL-6 are associated with increased plasma levels of these cytokines. The aims of this study were to evaluate the serum levels of acute phase reactants, such as C-reactive protein, and of cytokines (TNF-alpha and IL-6) and to investigate the association between the TNF-alpha-308 G/A and IL-6-174 G/C polymorphisms in Turkish pediatric patients with thrombosis. Fifty-eight children with thrombosis (group 1) and 89 controls (group 2) were included in the study. Patients who had a history of infection within the 15 days before thrombosis were classified as group 1a and those who had no infection history before thrombosis were classified as group 1b. Serum TNF-alpha did not differ significantly between the groups. However, the IL-6 level was higher in group 1a than in group 1b (P<0.05). The genotype distribution and allele frequencies of TNF-alpha G/A polymorphism were significantly higher in the thrombotic children without infection and in the control group than in the thrombotic children with an infection history (P<0.05). The IL-6-174 C/C genotype was significantly higher in thrombotic children with an infection history (P<0.05); there were no differences between the groups in mean allele frequency (Table 2). On the basis of our results, patients with a history of infection seem to have higher C-reactive protein and IL-6 levels and IL-6-174 C/C genotype. Furthermore, venous thrombosis is more frequent in this group than arterial thrombosis (P<0.05).     

TNF-α-308G/A和IL-6-174G/C基因多态性与呼吸道合胞病毒毛细支气管炎的相关性

目的：探讨肿瘤坏死因子(TNF)-α-308G/A、白细胞介素(IL)-6-174G/C基因多态性与呼吸道合胞病毒((RSV) 毛细支气管炎易感性的关系。方法：应用聚合酶链反应 限制性酶切片段长度多态性技术（PCR-RFLP）检测150例RSV毛细支气管炎患儿(病例组)和120例正常对照儿童(对照组)TNF-α-308G/A和IL-6-174G/C的基因多态性。结果：①病例组TNF-α-308位点GG、GA、AA基因型频率分别为68.0%、28.0%、4.0%,G、A等位基因型频率分别为82.0%,18.0%;对照组TNF-α-308位点GG,GA,AA基因型频率分别为80.8%,19.2%,0,G、A等位基因型频率分别为90.4%,9.6%;两组基因型及等位基因频率差异有显著性意义,病例组A等位基因的频率明显高于对照组(χ2=5.665,7.726,均P＜0.05);与G等位基因携带者相比,A等位基因携带者患RSV毛细支气管炎的风险增加了2.071倍(OR=2.071, P＜0.05);②病例组和对照组IL-6-174G/C位点均只见GG基因型。结论：TNF-α-308A等位基因与RSV毛细支气管炎的易感性相关,其可能是影响RSV毛细支气管炎发病的一个重要候选基因;温州地区汉族儿童未发现IL-6-174G/C基因多态性。［中国当代儿科杂志,2009,11（10）：821-824］     

Interleukin-6 -174 and -572 genotypes and the volume of deep gray matter in preterm infants

Preterm infants have smaller cerebral and cerebellar volumes at term compared with term born infants. Perinatal factors leading to the reduction in volumes are not well known. IL-6 -174 and -572 genotypes partly regulate individual immunologic responses and have also been connected with deviant neurologic development in preterm infants. Our hypothesis was that IL-6 -174 and -572 genetic polymorphisms are associated with brain lesions and regional brain volumes in very low birth weight or in very preterm infants. DNA was genotyped for IL-6 -174 and -572 polymorphisms (GG/GC/CC). Study infants (n = 175) were categorized into three groups according to the most pathologic brain finding in ultrasound examinations until term. The brain MRI performed at term was analyzed for regional brain volumes. Analyzed IL-6 genotypes did not show statistically significant association with structural brain lesions. However, IL-6 -174 CC and -572 GG genotypes associated with reduced volume of one brain region, the combined volume of basal ganglia and thalami, both in univariate and in multivariate analyses (p = 0.009, 0.009, respectively). The association of IL-6 -174 and -572 genetic polymorphisms with smaller volumes in deep gray matter provides us new ways to understand the processes leading to neurologic impairments in preterm infants.     

Determining acute complicated and uncomplicated appendicitis using serum and urine biomarkers: interleukin-6 and neutrophil gelatinase-associated lipocalin

The study aim is to determine whether serum and urine interleukin-6 (IL-6) and neutrophil gelatinase-associated lipocalin (NGAL) can be included in the early diagnostic algorithm for pediatric appendicitis. Prospective single-center cohort study included 92 children divided into control, acute complicated appendicitis (AcA) and acute uncomplicated appendicitis (AnA) groups. Serum and urine samples were assayed for IL-6 and NGAL preoperatively, and on the second and fifth postoperative days. Intraoperative and bacteriological findings divided the appendicitis patients. Average serum biomarker levels were higher in appendicitis patients versus the control, and the following values were produced via receiver operating characteristic (ROC) analysis. NGAL and IL-6 cutoff values were 113.95 ng/ml and 24.64 pg/ml, respectively, NGAL had 68.3% sensitivity and 65.5% specificity, while IL-6 had 72.6% and 86.2%. Comparing AcA and AnA, IL-6 was the only biomarker of significance yielding 77.4% sensitivity and 58.1% specificity with a 26.43 pg/ml cutoff value. Urine biomarkers were non-specific in differentiation appendicitis severity and ultimately, between infectious and non-infectious disease. Although NGAL provided measurable useful diagnostic information in evaluating children for appendicitis, its values were not sufficient for appendicitis severity. Serum IL-6 remains a strong biomarker for suspected acute appendicitis and has promising results predicting its severity.     

白细胞介素-4基因启动子多态性与广西壮族支气管哮喘患儿易感性和血清总免疫球蛋白E水平的相关性

目的研究IL-4基因启动子区域-589C/T和-33C/T位点多态性在广西壮族儿童中的分布及与壮族儿童支气管哮喘(哮喘)易感性及血清总IgE水平的相关性。方法采用聚合酶链反应-限制性片段长度多态性方法对健康儿童102例和哮喘患儿72例IL-4基因-589位点和-33位点进行分析,ELISA方法检测2组血清总IgE水平。采用SPSS 14.0软件进行统计学分析。结果1.IL-4-589位点在健康对照组中基因型分布频率为CC 5.9%、CT 23.5%、TT 70.6%,哮喘组为CC 2.8%、CT 19.4%、TT 77.8%;健康对照组等位基因频率为C 17.6%、T 82.4%,哮喘组为C 12.5%、T 87.5%。2.IL-4-33位点在健康对照组和哮喘组中基因型分布和等位基因频率与IL-4-589位点频率分布一致,连锁不平衡值△=0.978。3.哮喘组与健康对照组之间基因型频率和等位基因频率比较差异均无统计学意义(Pa>0.05)。4.哮喘组血清总IgE水平较健康对照组明显增高(P<0.01);各组不同基因型间血清总IgE水平比较差异均无统计学意义(Pa>0.05);3种相同基因型不同组间比较哮喘组血清总IgE水平均较健康对照组高(Pa<0.05)。结论在广西地区壮族儿童人群中,IL-4基因启动子-589位点和-33位点存在多态性,两位点存在连锁不平衡,其多态性与壮族儿童哮喘的易感性无关联,与血清总IgE水平无相关性。     

CTLA-4启动子-318C/T基因多态性与哮喘患儿血清总IgE水平的关系

目的探讨细胞毒T淋巴细胞相关抗原4(CTLA-4)启动子-318(C/T)基因多态性和吉林长春地区哮喘患儿血清总IgE水平的关系,以便为哮喘的诊治提供新线索。方法随机选取90例哮喘患儿及100例健康体检儿童作对照组,哮喘组和对照组的性别和年龄差异无统计学意义。采用聚合酶链式反应—限制性片段长度多态性(PCR-RFLP)技术对哮喘组和对照组CTLA-4启动子-318(C/T)基因多态性进行检测分析;同时采用酶联免疫吸附试验(ELISA)检测不同基因型哮喘患儿血清总IgE水平。结果CTLA-4启动子-318位点存在基因多态性。血清总IgE水平哮喘组(M=308.92 IU/ml,Q=254.75)高于正常对照组(M=36.66 IU/ml,Q=33.57),P<0.01;哮喘组中基因型为野生型(CC型,M=375.86 IU/ml,Q=139.95),高于突变型(TT型 CT型,M=141.25 IU/ml,Q=47.73),P<0.01。结论CTLA-4启动子-318(C/T)存在基因多态性,该位点的基因多态性可能引起血清总IgE水平下调。     

脓毒症儿童白细胞介素18基因启动子多态性研究

目的 研究白细胞介素(IL-18)基因启动子多态性位点以及相应血清IL-18含量与儿童脓毒症(Sepsis)的关系.方法 双抗体夹心酶联免疫吸附实验(ELISA)法、聚合酶链反应-序列特异性引物(PCR-SSP)和测序的方法 .两组间比较采用t检验,多组间比较采用方差分析,计数资料比较采用χ~2检验.结果 ①脓毒症患儿血清IL-18水平为(196.56±157.32)pg/ml,明显高于健康儿童的(66.16±41.63)PS/ml(P<0.01),随着脓毒症患儿病情的加重,血清IL-18浓度呈上升趋势,非危重组[(152.87±114.96)pg/ml]明显高于对照组[(66.16±41.63)pg/ml],危重组[(191.98±169.72)pg/ml]高于非危重组,极危重组血清IL-18浓度[(323.89±159.35)pg/ml]显著增高,差异有非常显著性(P=0.000),各组间比较差异均有显著性(P<0.01),相关分析发现血IL-18水平与小儿危重病例评分呈负相关(P<0.01).②健康儿童与脓毒症患儿均存在IL-18基因启动子多态性.健康儿童和脓毒症患儿-137G/C基因型频率分别为GG型(61.8%)、GC型(35.8%)、CC型(2.4%)和GG型(71.1%)、GC型(26.7%)、CC型(2.2%);等位基因的频率分别为G型(79.7%)和G型(84.4%).健康儿童和脓毒症患儿-60TC/A基因型频率分别为CA型(61.0%)、CC型(26.8%)、AA型(12.2%)和CA型(76.7%)、CC型(21.1%)、AA型(2.2%);等位基因的频率分别为C型(57.3%)和C型(59.4%).③脓毒症患儿-607CA基因型分布频率(76.7%)显著高于健康儿童(61.0%),AA基因型分布频率(2.2%)显著低于健康儿童(12.2%),差异均有显著性(P<0.05).④依-137CC、-137GC、-137GG顺序,健康儿童血清IL-18水平分别为:(45.67±28.36)pg/ml、(53.27±37.91)pg/ml、(76.91±42.44)pg/ml;而脓毒症患儿分别为:(140.50±60.10)pg/ml、(184.42±157.33)pg/ml、(237.02±161.76)pg/ml.依-607AA、-607CA、-607CC顺序,健康儿童血清IL-18水平分别为:(48.80±32.11)pg/ml、(68.41±42.53)ps/ml、(70.17±43.87)pg/ml;而脓毒症患儿分别为:(141.50±64.35)pg/ml、(151.21±121.19)pg/ml、(211.16±163.64)pg/ml.但差异无统计学意义(P>0.05).结论 脓毒症患儿血清IL-18水平明显升高,且与病情的加重有关.IL-18基因启动子-607CA基因型携带者儿童更易罹患脓毒症,表明-607CA基因型可能为脓毒症易感基因型,而-607AA基因型可能对儿童患脓毒症具有对抗作用.     

血清C反应蛋白、白介素-6和降钙素原对小儿急性复杂性阑尾炎的诊断价值研究

目的探索血清C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin 6,IL-6)和降钙素原(procalcitonin,PCT)水平对小儿急性复杂性阑尾炎的诊断价值。方法以2016年1月至2017年5月包头市第四医院小儿外科收治并进行手术治疗的96例急性阑尾炎患者为研究对象,分为两组:单纯性阑尾炎组30例,复杂性阑尾炎(包括化脓性阑尾炎及坏疽性阑尾炎)组66例,两组患者年龄、性别、体重差异均无统计学意义(P>0.05),检测两组患者术前血清CRP、IL-6、和PCT浓度,并绘制ROC曲线分析CRP、IL-6和PCT对小儿急性复杂性阑尾炎的诊断价值。结果复杂性阑尾炎组CRP、IL-6及PCT水平均显著高于单纯性阑尾炎组(P<0.05);以手术后病理结果为金标准,CRP、PCT、IL-6及三者联合检验ROC曲线下面积别为0.906(95%置信区间:0.829~0.956),0.953(95%置信区间:0.889~0.986),0.765(95%置信区间:0.668~0.846),0.973(95%置信区间:0.971~0.995)。曲线下面积值由大到小排序:PCT+CRP+IL-6>PCT>CRP>IL-6,通过两两比较发现,联合检验曲线下面积与CRP、IL-6单独检验曲线下面积比较差异具有统计学意义(Z=2.932,P=0.003;Z=3.854,P=0.0001);联合检验曲线下面积与PCT单独检验曲线下面积比较差异无统计学意义(Z=1.861,P=0.063);CRP与PCT单独检验曲线下面积差异无统计学意义(Z=1.668,P=0.095),IL-6单独检验与CRP单独检验、PCT单独检验比较曲线下面积差异具有统计学意义(Z=2.312,P=0.021;Z=3.371,P=0.001);得到最佳临界点分别为11.47(95%置信区间:11.42~14.48)mg/L,0.87(95%置信区间:0.63~0.98)ng/L,88.60(95%置信区间:87.12~170.83)pg/mL。结论CRP、IL-6和PCT有助于临床医师对阑尾炎严重程度进行早期判断,从而早期争取家长配合,尽早手术治疗并减少并发症的发生。