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目的探讨川崎病(KD)患儿治疗前后血浆可溶性血栓调节蛋白(sTM)含量变化及其临床意义。方法2004-07—2006-07入住南京医科大学附属南京儿童医院的KD患儿67例,将患儿分为无冠状动脉损伤组(39例)和冠状动脉损伤组(28例),按病程分为急性期、亚急性期和恢复期;另以28例健康儿童作为正常对照组。应用酶联免疫吸附法检测血浆sTM水平。结果急性期有、无冠状动脉损伤组血浆sTM质量浓度均明显高于正常对照组(均P<0.01),且冠状动脉损伤组血浆sTM蛋白水平亦显著高于无冠状动脉损伤组(P<0.01);治疗后sTM水平降低,冠状动脉损伤组KD患儿的血浆sTM水平急性期[(74.04±16.68)ng/mL]、亚急性期[(46.48±14.12)ng/mL]和恢复期[(38.94±12.93)ng/mL]均高于健康对照组[(14.00±5.58)ng/mL],差异有显著性(P<0.01);无冠状动脉损伤组KD患儿急性期[(37.06±14.55)ng/mL]、亚急性期[(34.04±12.47)ng/mL]sTM水平亦显著升高,与健康对照组相比差异有显著性(P<0.01),恢复期[(16.42±9.16)ng/mL]与正常组差异无显著性(P>0.05)。结论sTM可能参与了KD冠状动脉损伤的病理过程,检测sTM的水平对评估KD冠状动脉病变具有重要意义。
Objective To investigate the changes of plasma soluble thrombomodulin (sTM) levels in children with Kawasaki disease (KD) before and after treatment and its clinical significance. Methods A total of 67 children with KD admitted to Nanjing Children ’s Hospital affiliated to Nanjing Medical University from July 2004 to June 2006 were divided into two groups according to the duration of their courses of disease: coronary artery injury group (n = 39) and coronary artery injury group (n = 28) For the acute phase, subacute phase and recovery period; the other 28 healthy children as the normal control group. Plasma sTM levels were measured by enzyme-linked immunosorbent assay. Results The levels of plasma sTM in acute coronary artery injury group were significantly higher than those in normal control group (all P <0.01), and the plasma levels of sTM protein in coronary artery injury group were significantly higher than those in non-coronary artery injury group (P <0.01) ). After treatment, the level of sTM was decreased in acute coronary artery injury group [(74.04 ± 16.68) ng / mL], subacute phase [(46.48 ± 14.12) ng / mL] 38.94 ± 12.93 ng / mL] was significantly higher than that of the healthy controls [(14.00 ± 5.58) ng / mL] (P <0.01). The acute phase of KD without coronary artery injury [(37.06 ± 14.55 (34.04 ± 12.47) ng / mL] sTM was also significantly higher than that in the healthy controls (P <0.01), and recovery time was (16.42 ± 9.16) ng / mL, ng / mL] and normal group was no significant difference (P> 0.05). Conclusion sTM may be involved in the pathological process of KD coronary artery injury. To detect the level of sTM is of great significance for the evaluation of coronary artery disease in KD.