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目的观察不同的治疗方案下川崎病(KD)患儿治疗前和治疗后各阶段血浆白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、组织因子途径抑制物(TFPI)的变化,分析肝素对各指标的影响,探讨其作用机制。方法 2009年1月至2010年12月我院住院治疗的KD患儿56例。将住院KD患儿随机分为肝素治疗组和常规治疗组,并与健康体检儿童作对照。采用酶联免疫吸附法(ELISA)检测治疗前和治疗后各阶段患儿血浆IL-6、TNF-α和TFPI。结果 KD患儿治疗前血浆IL-6、TNF-α、TFPI较正常对照组儿童显著升高,差异有统计学意义(P<0.05);治疗后5～7 d、2～3周、2～3月血浆IL-6、TNF-α显著降低,TFPI显著升高。其中治疗后5～7 d,肝素治疗组血浆IL-6、TNF-α较常规治疗组下降显著(8.059±3.658 pg/ml vs 17.218±10.215 pg/ml,33.72±18.34 pg/ml vs 67.85±32.78 pg/ml);TFPI升高显著(50.367±10.246 vs 43.787±7.0594),可持续到2～3月(41.048±6.215 pg/ml vs 29.885±7.259 pg/ml),差异有统计学意义(P<0.05)。结论川崎病患儿急性期血浆IL-6、TNF-α、TFPI水平增高,肝素可通过进一步提高TFPI而降低IL-6、TNF-α水平,且TFPI升高持续时间较长,从而起到抗炎抗凝双重作用,减轻冠状动脉损害,减少血栓发生的风险。
Objective To observe the changes of plasma interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), inhibitor of tissue factor pathway (IL-6) in children with KD before and after treatment under different treatment regimens, TFPI) changes, analysis of heparin on the impact of various indicators to explore its mechanism of action. Methods 56 cases of KD children hospitalized in our hospital from January 2009 to December 2010. Inpatients with KD were randomly divided into heparin group and conventional treatment group, and compared with healthy children. Plasma IL-6, TNF-α and TFPI in children before and after treatment were measured by enzyme-linked immunosorbent assay (ELISA). Results The levels of plasma IL-6, TNF-α and TFPI in children with KD before treatment were significantly higher than those in normal controls (P <0.05). After treatment, the levels of IL-6, TNF- In March plasma IL-6, TNF-α decreased significantly, TFPI increased significantly. The levels of IL-6 and TNF-α in heparin group decreased significantly from 5 to 7 days after treatment (8.059 ± 3.658 pg / ml vs 17.218 ± 10.215 pg / ml, 33.72 ± 18.34 pg / ml vs 67.85 ± 32.78 (P <0.05). The TFPI increased significantly (50.367 ± 10.246 vs 43.787 ± 7.0594), and continued to 2-3 months (41.048 ± 6.215 pg / ml vs 29.885 ± 7.259 pg / ml) 0.05). Conclusions The plasma levels of IL-6, TNF-α and TFPI are increased in children with Kawasaki disease in the acute phase. Heparin can reduce the levels of IL-6 and TNF-α by further increasing the TFPI and prolonging the duration of TFPI Anticoagulant double effect, reduce coronary artery damage and reduce the risk of thrombosis.