本文選題：川崎病　切入點：靜脈丙種球蛋白　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過對102例川崎病患兒臨床資料進行回顧性分析,探索IVIG無反應(yīng)性川崎病的預(yù)測指標(biāo),并通過統(tǒng)計學(xué)分析得到相應(yīng)的診斷界值;通過實驗室研究探討CaSR與川崎病的關(guān)系。進一步闡明川崎病發(fā)病機制,為川崎病診斷治療提供新思路。方法1.選取2012年1月至2016年1月在天津醫(yī)科大學(xué)總醫(yī)院初診且臨床資料完整的102例KD患兒。其中男孩64例,女孩38例,年齡分布在3個月~8歲。入院后,所有患兒都給予IVIG治療,根據(jù)對治療是否敏感,分為IVIG敏感組和IVIG無反應(yīng)組。對其一般資料、臨床特征、實驗室檢查、輔助檢查等臨床資料進行回顧性研究及統(tǒng)計學(xué)分析,探尋預(yù)測IVIG無反應(yīng)性川崎病的特異性指標(biāo)。2.選擇2015年1月至2017年1月于我院兒科病房治療的KD患兒40例做為實驗組進行實驗室數(shù)據(jù)研究,其中男孩25例,女孩15例,平均年齡為1.95±1.69歲。另選取25例查體健康的兒童做為對照組,其中男孩15人,女孩10人,平均年齡為1.85±1.71歲。在應(yīng)用IVIG治療前,采用蛋白免疫印跡(Western Blot)技術(shù),檢測兩組研究對象外周血淋巴細胞中CaSR的表達情況;在應(yīng)用IVIG治療后,再次檢測KD組患兒CaSR表達情況。結(jié)果1.IVIG無反應(yīng)組KD患兒血漿NT-proBNP及CRP水平明顯高于IVIG敏感組,且為IVIG無反應(yīng)性KD發(fā)生的獨立危險因素。ROC曲線分析表明當(dāng)川崎病患兒血漿NT-proBNP濃度大于746.3ng/L時,發(fā)生IVIG無反應(yīng)的可能性大,靈敏度為0.917,特異度為0.674;當(dāng)CRP濃度大于100mg/L時,發(fā)生IVIG無反應(yīng)的可能性大,靈敏度=0.667,特異度=0.800;2.本研究通過實驗證實了IVIG治療前川崎病患兒外周血淋巴細胞確有CaSR的表達,有望而對照組CaSR不表達或表達量極少;IVIG治療后,CaSR表達顯著下降。結(jié)論1.血漿NT-proBNP及CRP水平升高作為預(yù)測川崎病患兒對丙種球蛋白是否敏感的特異性指標(biāo)有一定意義,但均存在局限性。2.川崎病患兒外周血淋巴細胞中確有CaSR的表達,為后續(xù)研究奠定基礎(chǔ),未來CaSR有望作為川崎病預(yù)測、診斷及治療的特異性指標(biāo),從而進一步闡明川崎病發(fā)病機制,為川崎病治療提供新思路。
[Abstract]:Objective to analyze the clinical data of 102 children with Kawasaki disease (Kawasaki disease), to explore the predictive index of IVIG nonreactive Kawasaki disease, and to obtain the corresponding diagnostic bounds by statistical analysis, and to explore the relationship between CaSR and Kawasaki disease by laboratory study.To further elucidate the pathogenesis of Kawasaki disease and provide a new idea for the diagnosis and treatment of Kawasaki disease.Method 1.102 children with KD were selected from January 2012 to January 2016 in Tianjin Medical University General Hospital.There were 64 boys and 38 girls, aged from 3 months to 8 years old.After admission, all children were treated with IVIG. According to the sensitivity of treatment, they were divided into IVIG sensitive group and IVIG nonreactive group.The general data, clinical characteristics, laboratory examination, auxiliary examination and other clinical data were analyzed retrospectively and statistically to find the specific index of predicting IVIG non-reactive Kawasaki disease. 2.From January 2015 to January 2017, 40 children with KD were selected as experimental group, 25 boys and 15 girls, with an average age of 1.95 鹵1.69 years.Another 25 healthy children were selected as control group, including 15 boys and 10 girls, with an average age of 1.85 鹵1.71 years.Before IVIG treatment, the expression of CaSR in peripheral blood lymphocytes was detected by Western blotting technique, and the expression of CaSR in KD group was detected again after IVIG treatment.Results the plasma levels of NT-proBNP and CRP in KD patients without 1.IVIG were significantly higher than those in IVIG sensitive children, and the plasma NT-proBNP levels in Kawasaki disease children were higher than those in Kawasaki disease patients, which was an independent risk factor for the occurrence of IVIG non-reactive KD.When the concentration of CRP was higher than that of 100mg/L, the possibility of no reaction of IVIG was high, the sensitivity was 0.667, and the specificity was 0.800 ~ 2 ~ (2), the sensitivity was 0.917 and the specificity was 0.674.When the concentration of CRP was higher than that of 100mg/L, the possibility of no reaction of IVIG was high.This study confirmed that the expression of CaSR in peripheral blood lymphocytes of children with Kawasaki disease before treatment with IVIG was confirmed. It is hopeful that the expression of CaSR in the control group is not expressed or is very small. The expression of CaSR in children with Kawasaki disease was significantly decreased after IVIG treatment.Conclusion 1.The increase of plasma NT-proBNP and CRP levels is a specific index to predict the sensitivity of serum gamma globulin to Kawasaki disease in children with Kawasaki disease.There is CaSR expression in peripheral blood lymphocytes of children with Kawasaki disease, which will lay a foundation for further study. In the future, CaSR may be used as a specific index for the prediction, diagnosis and treatment of Kawasaki disease, thus further elucidating the pathogenesis of Kawasaki disease.To provide a new idea for the treatment of Kawasaki disease.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.4

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