【摘要】 目的探讨川崎病(Kawasaki disease,KD)血清基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)及其特异性组织抑制物1(tissue inhibitor of metallop rote inase-1,TIMP-1)水平的动态变化在冠状动脉病变(coronary artery lesion,CAL)的预测和早期诊断中的临床价值。方法实验组KD合并CAL患儿15例,未合并CAL患儿44例,急性期静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG)前后、亚急性期及恢复期各抽取1次外周静脉血,对照组为20例正常体检儿童。ELISA双抗体法测定血清MMP-9与TIMP-1含量。结果KD患儿急性期血清MMP-9含量、TIMP-1含量及MMP-9/TIMP-1均较正常对照组增高(P<0.01);IVIG干预后KD患儿血清MMP-9含量与MMP-9/TIMP-1比值降低(P<0.01);KD合并CAL患儿IVIG干预前血清MMP-9含量及血清MMP-9/TIMP-1比值高于无CAL患儿(P<0.01)。结论川崎病冠状动脉病变患儿血清MMP-9含量与MMP-9/TIMP-1比值在急性期高于无冠状动脉病变患儿,提示MMP-9含量的急剧升高及与TIMP-1相互拮抗作用的失代偿可能是川崎病冠状动脉病变的高风险因素,动态监测血清MMP-9含量和(或)MMP-9/TIMP-1比值对预测和早期诊断川崎病合并冠脉病变具有重要的临床意义。更多还原

【Abstract】 Objective Kawasaki disease (KD) complicated with coronary artery lesion (CAL) seriously threatens survival quality and life of patients, suggesting that it is very important to early predict the risk of CAL and to early diagnose the disease.Nevertheless, up to now there has been no specific clinical biochemical marker for it because of the poor understanding of the pathological process of KD with CAL.Matrix metalloproteinases (MMPs) and their specific tissue inhibitor of metalloproteinases (TIMPs) play an important role in arterial wall extracellular matrix breakdown and remodeling and are involved in CAL in other diseases.In the present study the practical value of serum MMP-9 and TIMP-1 levels in the prediction and early diagnosis of CAL in KD patients was investigated.Methods All subjects were from Chinese population.Serum levels of MMP-9 and TIMP-1 were measured by rapid one-step sandwich enzyme immunoassay in 59 KD patients including 15 with CAL and 44 without CAL by 2 D-echocardiography and coronary angiography, and 20 normal healthy children as controls.Blood samples of patients were obtained before and after intravenous immunoglobulin (IVIG) treatment in acute stage, subacute stage and convalescent stage as well.Serum MMP-9 and TIMP-1 levels and the ratio of MMP-9/TIMP-1 were compared by statistical method in KD patients and controls, as well as in KD with CAL and without CAL. Results In acute stage serum MMP-9 and TIMP-1 levels and the ratio of MMP-9/TIMP-1 were higher (P<0.01)in patients with KD than those in healthy children.After IVIG treatment in KD patients serum MMP-9 level and the ratio of MMP-9/TIMP-1 decreased (P<0.01).Before IVIG treatment serum MMP-9 level and the ratio of MMP-9/TIMP-1 were higher(P<0.01) in patients with CAL than those in patients without CAL, and in acute stage after IVIG treatment serum MMP-9 level of KD patients with CAL was still higher than that of KD patients without CAL.Conclusion In acute stage of KD serum MMP-9 level and the ratio of MMP-9/ TIMP-1 were higher in patients with CAL than those in patients without CAL, suggesting that during acute phase of KD the great increase in serum MMP-9 and the imbalance of the MMP-9/TIMP-1 ratio might be high risk factors of KD coronary artery lesion.Therefore, the measurement of serum MMP-9 and TIMP-1 might be of important clinical value in the prediction and the early diagnosis of KD with coronary artery lesion.更多还原