川崎病患儿CD4+T淋巴细胞表面CD40L表达及其与冠状动脉损伤的关系

目的通过检测川崎病(KD)患儿静脉输注入血丙种球蛋白(丙球)治疗前后外周血T细胞表面CD40L(CD154)表达,探讨KD冠状动脉损伤的发病机制。方法采用流式细胞仪检测26例KD患儿静脉输注丙球治疗前后、16例其他发热性疾病患儿、15例正常儿童外局血T细胞表面的CD40L表达。采用酶联免疫吸附试验检测相应血清中E-选择素。结果KD患儿CD4 T细胞表面CD40L表达及血清E-选择素显著高于其他发热性疾病组及正常对照组(P<0.01),KD患儿静脉输注丙球治疗后明显下降(P<0.01)。CD4 T细胞表面CD40L表达及E-选择素与KD冠状动脉损伤有关,而CD8 T细胞表面CD40L的表达与冠状动脉损伤无关。KD患儿CD4 T细胞表面CD40L表达与E-选择素水平正相关(r=0.626P<0.05)。结论CD40L异常表达及血清E-选择素在KD发病机制中起重要作用。静脉输注丙球能下调CD40L表达及血清E-选择索,有利于血管炎治疗。

CD4o Ligand Expression on CD4 + T-Cells in Children with Kawasaki Disease and Its Correlation with Coronary Artery Lesion

Objective To explore the pathogenesis of coronary artery lesions in Kawasaki disease(KD) by detecting expression of CD40 ligand (CD40L )on T - cells from children with KD. Methods Blood samples were collected from 26 children with KD before and after intravenous immunoglobulin( IVIG) treatment. Age - matched febrile 16 children with various diseases were studied in parallel as controls. Age - matched normal control 15 children were studied as controls. CD40L expression on T - cells was detected by flow cy-tometry, and soluble E - selection levels were measured by enzyme - linked immunosorbent assay. Results CD40L expression on CD4 T- cells and soluble E- selection levels were significantly higher in children with KD than that in the febrile control(FC) group and normal group (P<0.01). CD40L expression and soluble E-selection levels decreased significantly 2-3 days after IVIG administra-tion(P<0.01). In KD children , CD40L expression on CD4 T- cells and E- selection was correlated with the occurrence of coronary artery lesions but not CD40L expression on CD8 T - cells. There was a significantly positive correlation between CD40L expression on CD4 T - cells in children with KD and E - selection( r = 0.626 P < 0.05). Conclusions CD40L and E - selection might play a role in the immunopathogenesis of KD. IVIG therapy may downregulate CD40L expression and may benefit to recovery of KD vascutitis.