A&R：血清TH1/TH2细胞因子水平有助于预测川崎病患儿疾病缓解状况

来自中国杭州的浙江大学儿童医院的王羽佳等人进行了一项研究，该研究的目的是调查血清TH1和TH2细胞因子在川崎病（KD）中的意义，并确定川崎病患儿的TH1/TH2细胞因子水平是否与静脉使用丙种球蛋白（IVIG）抵抗和冠状动脉病变（CALs）有关。研究结果在线发布在2013年3月的ARTHRITIS & RHEUMATISM（关节炎与风湿病）上。研究者发现，血清TH1/TH2细胞因子水平有助于KD患者疾病缓解和靶向治疗的预测。

血清TH1和TH2细胞因子，包括干扰素-γ（IFN-γ）、肿瘤坏死因子-α（TNF-α）、白介素-10（IL-10）、IL-6、IL-4和IL-2等。研究者共招募了143位KD患者，以微量样本多指标流式蛋白定量技术，分别在IVIG治疗前后对上述研究对象的TH1和TH2细胞因子进行检测（pre-IVIG，IVIG治疗体温正常后三天[post-IVIG]，治疗接受后一个月）。

研究结果显示，KD患者在IVIG治疗前，血清IL-6、IL-10、TNF-α和IFN-γ水平显著升高。IVIG治疗后，血清IL-6、IL-10和IFN-γ水平显著下降。不合并post-CALs且对IVIG有效的KD患者经IVIG治疗后，TNF-α水平显著下降；然而，合并post-CALs，或者对IVIG无反应的KD患者经IVIG治疗后，TNF-α轻度升高。在IVIG治疗前，合并CALs的KD患者的IL-4、IL-6、IL-10和IFN-γ水平显著高于不合并CALs的患者。IVIG治疗后，对IVIG无反应者的IL-6、IL-10显著高于对IVIG有反应者。IVIG治疗前，IL-10水平>8 pg/ml，对CALs预测的敏感性是75%，特异性是64.4%。然而，TNF-α<2 pg/ml对IVIG抵抗的预测的敏感性66.7%和特异性74.2%。IVIG治疗后，IL-6水平>10 pg/ml，对CALs预测的敏感性是67.9%，特异性是81.7%，然而，IL-10水平>6 pg/ml，对CALs预测的敏感性是53.6%，特异性是86%。

研究发现，血清TH1/TH2细胞因子水平有助于KD患儿疾病缓解和靶向治疗的预测。
与川崎病相关的拓展阅读：

• 川崎病患者长期心血管风险低
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Evaluation of intravenous immunoglobulin resistance and coronary artery lesions in relation to Th1/Th2 cytokine profiles in patients with Kawasaki disease.
OBJECTIVE
To investigate the roles of serum Th1 and Th2 cytokines in Kawasaki disease (KD) and determine whether the Th1/Th2 cytokine profiles in children with KD may be involved in intravenous immunoglobulin (IVIG) resistance and development of coronary artery lesions (CALs).
METHODS
Serum Th1 and Th2 cytokines, including interferon-γ (IFNγ), tumor necrosis factor α (TNFα), interleukin-10 (IL-10), IL-6, IL-4, and IL-2, were measured using a cytometric bead array in the serum of 143 patients with KD before and after treatment with IVIG (pre-IVIG, at 3 days after temperature normalization following IVIG treatment [post-IVIG], and 1 month posttreatment).
RESULTS
Levels of IL-6, IL-10, TNFα, and IFNγ were significantly increased in KD patients pre-IVIG. Post-IVIG, the levels of IL-6, IL-10, and IFNγ quickly decreased. The levels of TNFα decreased significantly after IVIG treatment in KD patients without CALs post-IVIG and in KD patients who were IVIG responders, but increased slightly in KD patients with CALs post-IVIG and in KD patients who were IVIG nonresponders. Before IVIG treatment, the levels of IL-4, IL-6, IL-10, and IFNγ were significantly higher in KD patients with CALs than in those without CALs. The post-IVIG levels of IL-6 and IL-10 were significantly higher in IVIG nonresponders than in IVIG responders. Pre-IVIG, an IL-10 level >8 pg/ml had a sensitivity of 75.0% and a specificity of 64.4% for predicting CALs, while a TNFα level <2 pg/ml had a sensitivity of 66.7% and a specificity of 74.2% for predicting IVIG resistance. Post-IVIG, an IL-6 level >10 pg/ml had a sensitivity of 67.9% and a specificity of 81.7% for predicting CALs, while an IL-10 level >6 pg/ml had a sensitivity of 53.6% and a specificity of 86% for predicting CALs.
CONCLUSION
Determination of the serum Th1/Th2 cytokine profile may be helpful for predicting the disease prognosis and targeting treatment strategies in patients with KD.