Meprin A、IL-1β与静脉丙种球蛋白无效型川崎病的关联性研究

目的 探讨Meprin A、白细胞介素 1β在预测静脉丙种球蛋白（IVIG）无效型川崎病(KD)中的价值。方法 前瞻性选取410例KD患儿为试验组，同期住院的上呼吸道感染患儿201例为对照组。试验组按初始IVIG治疗效果分为IVIG 有效组与IVIG 无效组。所有KD患儿在急性期、恢复期检测血Meprin A、IL 1β等实验室指标。结果 ①KD患儿急性期血Meprin A、IL 1β水平显著高于对照组及缓解期(P<0.01)。②KD患儿急性期血Meprin A与IL 1β水平之间呈强正相关性(r=0.635，P＜0.01) 。③IVIG 无效组血Meprin A、IL 1β水平显著高于IVIG 有效组，且两组间热程、首剂应用IVIG时间、WBC、CRP、ESR、NT proBNP等差异均有统计学意义（P＜0.01）。④当血清Meprin A≥12.95 ng/ml，预测IVIG 无效型KD的敏感性为81.8%，特异性为89.6%；当IL 1β≥4.05 pg/ml, 敏感性为61.8%, 特异性为87.3%； 当同时满足Meprin A≥12.95 ng/ml及IL 1β≥4.05 pg/ml时，特异性达94.9%。结论 Meprin A及IL 1β或参与KD的致病过程，可作为评估KD疾病活动性的指标，且能较好预测IVIG 无效型KD。

Association amongmeprin A,IL-1β and IVIG-ineffective Kawasaki disease

Objective To explore the predictive value of meprin A and interleukin 1β for gamma globulinin ineffective Kawasaki disease(KD).Methods A total of 410 KD patients were selected as test group, and 210 patients with upper respiratory tract infection were selected as control group. KD patients were further divided into IVIG effective group and IVIG ineffective group according to the initial treatment outcome of IVIG. All KD patients were tested for laboratory indicators, such as meprin A and IL 1β in acute and recovery phase.Results ①The levels of IL 1β and meprin A in KD patients in the acute phase were higher than those in the control group and in KD patients in the remissionphase (P<0.01). ②There was strong positive correlation between meprin A and IL 1β levels in KD children（r=0.635，P<0.01）.③ The levels of meprin A and IL 1β in IVIG ineffective group were higher than those in IVIG effective group. There were statistically significant differences in the feverprocess，the first application of intravenous gamma globulin，blood WBC，CRP，ESR and NT proBNP between the two groups (P<0.01). ④ When the blood meprin A was higher than or equal to 12.95 ng/ml，its sensitivity and specificity for predicting IVIG ineffective KD was 81.8％ and 89.6％，respectively；When IL 1β was higher than or equal to 4.05 pg/ml，its sensitivity and specificity was 61.8％ and 87.3％，respectively；When both of the above conditions were met，the specificity was 94.9%.Conclusion Meprin A and IL 1β may participate in the pathogenesis of KD, so they can be seen as an indicator to evaluate the disease activity of KD and better predict IVIG ineffective KD.