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目的检测川崎病(KD)患儿血清金黄色葡萄球菌相关超抗原,探讨KD的病因。方法 2010年1月至2010年10月在成都市儿童医院住院的70例KD患儿为研究对象,分别用双抗体酶联免疫吸附法(ELISA)检测KD患儿、42例急性感染性疾病患儿(IC)和48例健康儿童(HC)血清中金黄色葡萄球菌蛋白A(SPA)、中毒休克综合征毒素-1(TSST-1)、肠毒素(SE)、A组链球菌菌壁多糖抗体(ASP)、人金黄色葡萄球菌抗原(HSPA-Ag)和人A组链球菌抗原(HASP-Ag)。取KD组和IC组患儿的静脉血、咽分泌物及粪便做细菌培养。结果 KD组SPA和TSST-1分别为(1.93±0.35)μg/mL和(6.50±1.15)μg/mL,IC组SPA和TSST-1分别为(1.19±0.24)μg/mL和(6.78±1.03)μg/mL,HC组SPA和TSST-1分别为(1.27±0.29)μg/mL和(5.42±0.92)μg/mL;3组比较差异有统计学意义(P<0.05)。3组间SE、ASP、HSPA-Ag、HASP-Ag比较,差异均无统计学意义。70例KD患儿中血培养阳性8例(11.4%);咽拭子培养阳性4例(5.7%),粪培养阳性者0例;42例IC组中血培养阳性0例,咽拭子培养阳性1例(2.4%),粪培养阳性0例。KD组血培养阳性率较IC组明显增高,差异有统计学意义(P<0.05)。结论 SPA和TSST-1介导的超抗原反应与KD的发生可能存在相关性,尚未发现A组链球菌相关毒素在KD发病中的可能作用。KD患儿的毒血症状较普通感染性疾病明显,认为细菌感染可能参与KD的发病。
Objective To detect serum S aureus-associated superantigens in children with Kawasaki disease (KD) and to explore the etiology of KD. METHODS: From January 2010 to October 2010, 70 children with KD admitted to Children’s Hospital of Chengdu were enrolled in this study. KD children were detected by ELISA and 42 patients with acute infectious diseases Serum levels of Staphylococcus aureus protein (SPA), toxic shock syndrome toxin-1 (TSST-1), enterotoxin (SE), streptococcal wall polysaccharides of group A and 48 healthy children (HC) Antibody (ASP), human Staphylococcus aureus antigen (HSPA-Ag) and human Group A streptococcal antigen (HASP-Ag). Take KD group and IC group of children with venous blood, pharyngeal secretions and faeces do bacterial culture. Results The SPA and TSST-1 in KD group were (1.93 ± 0.35) μg / mL and (6.50 ± 1.15) μg / mL, respectively. The SPA and TSST-1 in ICD group were 1.19 ± 0.24 μg / mL and 6.78 ± 1.03 ) (1.27 ± 0.29) μg / mL and (5.42 ± 0.92) μg / mL, respectively. The differences between the three groups were statistically significant (P <0.05). SE, ASP, HSPA-Ag, HASP-Ag between the three groups, the difference was not statistically significant. Among 70 KD children, 8 were positive for blood culture (11.4%), 4 were positive for pharyngeal swab (5.7%), 0 were positive for stool culture, 0 was positive for blood culture from 42 patients in IC group, 1 case (2.4%) was positive, 0 case was positive for fecal culture. The positive rate of blood culture in KD group was significantly higher than that in IC group, the difference was statistically significant (P <0.05). Conclusion The possible association between SPA and TSST-1-mediated superantigen reaction and the occurrence of KD may not be found. The possible role of group A streptococcal related toxins in the pathogenesis of KD has not been found yet. KD in children with signs of poisoning than the general infectious diseases significantly, that bacterial infection may be involved in the pathogenesis of KD.