川崎病患儿内源性血管弹性蛋白酶变化及其与冠脉损伤的关系

临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (4): 319-322.

川崎病患儿内源性血管弹性蛋白酶变化及其与冠脉损伤的关系

柳颐龄，王献民，李焰，郭永宏，杨艳峰，石坤，陈婷婷

成都市妇女儿童中心医院儿童心内科（四川成都　610091）

收稿日期:2013-10-14 出版日期:2014-04-15 发布日期:2014-04-15

Changes of endogenous vascular elastase in Kawasaki diseases and its role in the pathogenesis of coronary artery lesions　

LIU Yiling, WANG Xianmin, LI Yan, GUO Yonghong, YANG Yanfeng, SHI Kun, CHEN Tingting

(Department of Pediatric Cardiology, Chengdu Women's & Children's Central Hospital, Chengdu 610017, Sichuan, China)

Received:2013-10-14 Online:2014-04-15 Published:2014-04-15

摘要/Abstract

摘要：

　目的　探讨内源性血管弹性蛋白酶（EVE）对川崎病（KD）患儿冠脉损害的作用机制。方法　选取2012年1月至2013年4月住院治疗的60例KD患儿为研究对象，以同期60 例呼吸道感染发热患儿为对照组。采用超声心动图检测患儿冠状动脉扩张程度；采用双抗体夹心酶联免疫吸附法测定血EVE、基质金属蛋白酶9（MMP-9）和转化生长因子β1（TGF-β1），并分析其与冠状动脉直径的相关性。结果　KD患儿急性期血EVE、MMP-9、TGF-β1水平明显高于对照组，差异有统计学意义（P<0.01）；并发冠脉病变的KD患儿的EVE水平明显高于无冠脉损害患儿，且EVE、MMP-9、TGF-β1水平与冠脉扩张程度成显著正相关（r=0.64~0.79，P<0.01）。结论　EVE在KD冠脉病变中，可能是通过诱导MMP-9、TGF-β1合成而引起冠脉损伤。

Abstract: Objective　To explore the potential role of endogenous vascular elastase (EVE) in pathogenesis of coronary artery lesions (CAL) in Kawasaki diseases (KD). Methods A total of 60 children with KD admitted from Jan. 2012 to Apr. 2013 were enrolled, and at the same time 60 febrile children with respiratory infection were enrolled as controls. The left and right coronary artery diameter value was measured by ultrasonic cardiogram. The levels of EVE, matrix metalloproteinases (MMP)-9 and transforming growth factor (TGF) -β1were determined by enzyme-linked immunosorbent assay and their correlations with coronary artery diameter were analyzed. Results The levels of EVE, MMP-9 and TGF-β1 in KD children in the acute phase were significantly higher than those in control group (P<0.01). Meanwhile, the level of EVE in KD children with coronary artery lesion (CAL) is significantly higher than that in KD children without CAL. The results of correlation analysis indicated that the levels of EVE, MMP-9 and TGF-β1 were positively correlated with coronary artery diameters (r=0.64~0.79, P<0.01). Conclusions EVE plays an important role in the CAL of KD may through inducing the produce of MMP-9, TGF-β1 and finally causing the formation of CAL.

柳颐龄，王献民，李焰，郭永宏，杨艳峰，石坤，陈婷婷. 川崎病患儿内源性血管弹性蛋白酶变化及其与冠脉损伤的关系[J]. 临床儿科杂志, 2014, 32(4): 319-322.

LIU Yiling,WANG Xianmin,LI Yan,GUO Yonghong,YANG Yanfeng,SHI Kun,CHEN Tingting. Changes of endogenous vascular elastase in Kawasaki diseases and its role in the pathogenesis of coronary artery lesions　[J]. , 2014, 32(4): 319-322.

参考文献

[1] Yeom JS，Woo HO，Park JS，et al. Kawasaki disease in infants[J]. Korean J Pediatr，2013，56(9)：377-382.
[2] Murakami T，Tanaka N. The physiological significance of coronary aneurysms in Kawasaki disease [J]. EuroIntervention，2011，7(8)：944-947.
[3] 傅立军，周爱卿，沈捷，等. 肺动脉高压时内源性血管弹性蛋白酶的动态变化与肺血管重建关系的实验研究[J]. 中国当代儿科杂志，2005，7(06)：479-482.
[4] 傅立军，周爱卿，沈捷，等. 弹性蛋白酶抑制剂对野百合碱诱导的肺动脉高压干预作用的研究 [J]. 中华儿科杂志，2004，42(05)：59-62.
[5] Ayusawa M，Sonobe T，Uemura S，et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition) [J]. Pediatr Int，2005，47(2)：232-234.
[6] 李焰，王献民，柳颐龄，等. 川崎病患儿并发冠状动脉病变的危险因素分析 [J]. 中国当代儿科杂志，2012，14(12)：938-941.
[7] Alam SR，Newby DE，Henriksen PA. Role of the endogenous elastase inhibitor，elafin，in cardiovascular injury：from epithelium to endothelium [J]. Biochem Pharmacol，2012，83(6)：695-704.
[8] 傅立军，周爱卿. 内源性血管弹性蛋白酶及其抑制剂与肺动脉高压的关系 [J]. 中华儿科杂志，2002，40(8)：62-64.
[9] Bajolle F，Laux D. Kawasaki disease：what you need to know [J]. Arch pediatr，2012，19(11)：1264-1268.
[10] Korematsu S，Ohta Y，Tamai N，et al. Cell distribution differences of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in patients with Kawasaki disease [J]. Pediatr Infect Dis J，2012，31(9)：973-974.
[11] Sakata K，Hamaoka K，Ozawa S，et al. Matrix metalloproteinase-9 in vascular lesions and endothelial regulation in Kawasaki disease[J]. Circ J，2010，74(8)：1670-1675.
[12] Shimizu C，Oharaseki T，Takahashi K，et al. The role of TGF-beta and myofibroblasts in the arteritis of Kawasaki disease [J]. Hum Pathol，2013，44(2)：189-198.
[13] 段春红，马香，刘雪梅，等. 川崎病患儿生长因子及生长转化因子变化与冠状动脉直径相关性的研究 [J]. 中国实用儿科杂志，2011，26(02)：136-137.