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目的探讨川崎病(KD)患儿血清基质金属蛋白酶-9(MMP-9)及其特异性组织抑制剂1(TIMP-1)质量浓度的变化在预测发生冠状动脉病变(CAL)风险中的临床意义。方法观察组为2003~2004年在四川大学华西第二医院与四川省人民医院住院的KD患儿32例,静脉注射丙种球蛋白(IVIG)前后各抽取患儿外周静脉血1次,同时抽取20名正常体检儿童(正常对照组)外周静脉血。ELISA双抗体法测定血清MMP-9与TIMP-1质量浓度。用二维超声心动图观察心脏冠状动脉病变。结果观察组患儿急性期血清MMP-9、TIMP-1质量浓度及MMP-9/TIMP-1比值均较正常对照组儿童显著增高(P<0.01);IVIG干预前CAL组患儿血清MMP-9质量浓度及血清MMP-9/TIMP-1显著地高于非CAL组患儿(P<0.01);IVIG干预后观察组患儿血清MMP-9质量浓度与MMP-9/TIMP-1显著降低(P<0.01);IVIG干预后CAL组患儿血清MMP-9质量浓度及血清MMP-9/TIMP-1仍显著高于非CAL组患儿(P<0.05),而后者MMP-9/TIMP-1基本降至正常儿童水平;观察组患儿血清TIMP-1质量浓度在IVIG干预前后无显著变化。结论MMP-9与TIMP-1可作为KD合并CAL的一种关联因素,动态监测血清MMP-9质量浓度和(或)MMP-9/TIMP-1比值对预测KD并发CAL具有较重要临床意义。
Objective To investigate the changes of serum matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of tissue-specific inhibitor 1 (TIMP-1) in children with Kawasaki disease (KD) in the prediction of the risk of coronary artery disease (CAL) significance. Methods The observation group was 32 KD children hospitalized in West China Second Hospital and Sichuan Provincial People ’s Hospital of Sichuan University from 2003 to 2004. Peripheral venous blood was drawn once before and after intravenous injection of IVIG and 20 Normal physical examination children (normal control group) peripheral venous blood. Serum levels of MMP-9 and TIMP-1 were detected by ELISA double antibody method. Coronary artery lesions were observed with two-dimensional echocardiography. Results The serum levels of MMP-9, TIMP-1 and the ratio of MMP-9 / TIMP-1 in children in observation group were significantly higher than those in normal control group (P <0.01) 9 concentration and serum MMP-9 / TIMP-1 were significantly higher than those in non-CAL children (P <0.01). The levels of serum MMP-9 and MMP-9 / TIMP-1 in the observation group were significantly lower after IVIG intervention (P <0.01). The levels of serum MMP-9 and serum MMP-9 / TIMP-1 in CAL group were still significantly higher than those in non-CAL group (P <0.05) -1 to normal children’s level. The serum level of TIMP-1 in observation group had no significant change before and after IVIG intervention. Conclusions MMP-9 and TIMP-1 can be used as a correlative factor for KD combined with CAL. Dynamic monitoring of serum MMP-9 concentration and / or MMP-9 / TIMP-1 ratio has important clinical significance in predicting KD complicated with CAL.