目的 探讨急性期川崎病（KD）患儿外周血树突状细胞（DC）亚群的变化及意义。方法 回顾性分析2020年12月—2021年5月就诊的初发急性期KD患儿的临床资料。KD患儿分别于静脉注射用免疫球蛋白（IVIG）治疗前、后取血,采用流式细胞术检测外周血DC亚群浆细胞样树突状细胞（pDC）及CD1c⁺髓样树突状细胞（mDC）数量和比例及表面功能分子HLA-DR、CD86、CD40蛋白表达水平。选择同期健康体检儿童作为对照组。结果 KD组患儿32例,男19例、女13例,中位年龄37.0（22.3~58.5）月。对照组23例,男14例、女9例,中位年龄52.0（30.0~65.0）月。KD组患儿IVIG治疗前、治疗后的pDC、CD1c⁺mDC占外周血总DC比例均低于对照组,治疗后组CD1c⁺mDC占外周血总DC比例高于治疗前;治疗前组pDC、CD1c⁺mDC数量低于对照组和治疗后组,差异均有统计学意义（P<0.05）。治疗前组pDC表面CD86、CD40表达以及CD1c⁺mDC表面HLA-DR、CD86水平均低于对照组和治疗后组,差异有统计学意义（P<0.05）。急性期KD患儿pDC和CD1c⁺mDC数量与C反应蛋白、中性粒细胞与淋巴细胞比值均呈显著负相关（P<0.05）;CD1c⁺mDC细胞数量与血沉也呈显著负相关（P<0.05）。结论 KD患儿外周血循环中pDC和CD1c⁺mDC存在数量不足及功能受损,pDC和CD1c⁺mDC可能参与了KD的发病过程。

Objective To investigate the changes of dendritic cell (DC) subsets in children with acute Kawasaki disease (KD) and their significance. Methods The clinical data of children with initial acute KD from December 2020 to May 2021 were retrospectively analyzed. Blood samples of KD children were taken before and after intravenous immunoglobulin (IVIG) treatment. Flow cytometry was used to detect the number and proportion of DC subgroup plasmacytoid dendritic cells (pDC) and CD1c⁺ myeloid dendritic cells (mDC) in peripheral blood as well as the expression levels of human leucocyte antigen-DR (HLA-DR), CD86 and CD40 proteins. Children who underwent physical examination at the same period were selected as the control group. Results There were 32 children (19 boys and 13 girls) in the KD group, and the median age was 37.0 (22.3-58.5) months. In the control group, there were 23 children (14 boys and 9 girls) and the median age was 52.0 (30.0-65.0) months. The proportion of pDC and CD1c⁺mDC in peripheral blood DCs before and after IVIG treatment in KD group was lower than that in control group, and the proportion of CD1c⁺mDC in peripheral blood DCs after treatment was higher than that before treatment. The number of pDC and CD1c⁺mDC in pre-treatment group was lower than that in control group and post-treatment group, and the differences were statistically significant (P<0.05). The expression levels of CD86 and CD40 on pDC surface and the expression levels of HLA-DR and CD86 on CD1c⁺mDC surface were lower than those in control group and post-treatment group, with statistical significance (P<0.05). The number of pDC and CD1c⁺mDC in KD children in acute stage was significantly negatively correlated with c-reactive protein and neutrophil to lymphocyte ratio (P<0.05). The number of CD1c⁺mDC was also negatively correlated with ESR (P<0.05). Conclusions The number of pDC and CD1c⁺mDC in peripheral blood circulation of KD children was insufficient and their function was impaired. Circulating pDC and CD1c⁺mDC may be involved in the immunological pathogenesis of KD.