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Variation and Clinical Significance of Interleukine-17and Th17Cell in the Peripheral Blood of Patients with Incomplete Kawasaki Disease

Author: LiYunYan
Tutor: DiYaZhen
School: Ningbo University
Course: Internal Medicine
Keywords: Kawasaki disease Incomplete Th17cell IL-17
CLC: R725.4
Type: Master's thesis
Year: 2013
Downloads: 2
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Abstract


BACKGROUND:Kawasaki disease(KD) is a kind of unknown etiology of acute, immunity,vasculitis disease, with serious complication of coronary artery lesions(CALs). Incomplete Kawasaki disease(IKD)’s clinical characteristics is lessthan KD, and the incidence rate of CALs is higher than KD, so people pay moreattention to it. The etiology and pathogenesis of KD are not yet fullyunderstood. It is confirmed that the abnormal proinflammatory cytokinescell factor and chemokines of children with KD involved in itspathogenesis. Th17is a newly identified CD4+cell subsets, inducing a varietyof pro-inflammatory cytokines and chemokines by secretion of interleukin-17(IL-17), and it participate in inflammatory reaction and immunereaction. Research has suggested Th17cells may be involved in the immunepathogenesis of KD. This paper investigates whether the change of KD inperipheral blood Th17cells and related cytokines levels are consistent withthose from previous studies, and also research in the changes of IKD in Th17cells and related cytokines and its clinical significance.PURPOSE:We detected peripheral blood Th17cells ratio of CD4+cells and serum IL-17level of30cases of Kawasaki disease (KD) children (KD group) and30cases of incomplete Kawasaki disease (IKD) children (IKD group) in acuteand recovery phase, and we detected peripheral blood Th17cells ratio ofCD4+cells and serum IL-17level of13cases of inguinal herniasurgery and17cases of health in children as control group. We use statistical analysis toall the data. At the same time, we detected the white blood cell count (WBC), C reactive protein(CRP), erythrocytesedimentation rate (ESR), albumin, globulin, B type natriuretic peptide(NT-proBNP). We also examined the30children with KD and30cases of childrenwith IKD of ECG andultrasound heartbeat graph examination, to discuss theprobably mechanism of action and changes and clinical significance ofCD4+Th17cells and IL-17in pathogenesis of KD and IKD.METHOD:The collection of KD, IKD were30cases each in Ningbo women andchildren’s Hospital pediatric in rheumatology in2012March-2012December,while collecting hospitalized children in our hospital during the same periodsurgical13cases with indirect inguinal hernia surgery and17cases withoutpatient health physical examination in children which matched with these insex and age. We collected their peripheral blood, after treated in vitrostimulated processing, fixed membrane rupture intracellular staining, etc. weflow cytometry and CD4+Th17cell ratio, while we detect KD, IKD and serum IL-17level by the application of ELISA method. Automatic quantitative analysisof plasma NT-proBNP were detected by French Biomerieux Sa company mini-VIDASautomatic enzyme-linked fluorescent analyzer and supporting VIDAS NT-proNT-proBNP reagent, and albumin and globulin detection by OLYMPUS AU2700biochemical analyzer, and albumin by bromocresol green method, total proteinusing the biuret method, globulin by reducing the total protein albumin. Thedetection of C-reactive protein (CRP) turbidity method. The Westergren ESR(ESR) detection. Using automatic blood analyzer white blood cell count (WBC).RESULT:1.Group KD, group IKD in acute stage、recovery stage and the controlgroups, electrocardiogram and (or) ultrasound heartbeat graph group with theabnormal electrocardiogram and ultrasonic heartbeat graph of normal peripheralblood Th17cell ratio.KD (n=30) in children with acute peripheral blood Th17ratio is higher thanthat of the control group (n=30),(1.77±0.16vs0.12±0.08,P<0.05); IKD(n=30) in children with acute peripheral blood Th17ratio is higher than that of the control group (n=30),(1.83±0.15vs0.12±0.08,P<0.05); KD group andIKD group of acute peripheral blood Th17ratio had no significant difference;KD group, IKD group and control group, recovery of peripheral blood Th17ratiohad no significant difference; electrocardiogram and (or) ultrasound heartbeatgraph in abnormal group (n=18) of peripheral blood Th17ratio is higher thanthat of ECG and ultrasound heartbeat graph is normal group (n=42),(1.88±0.16vs1.77±0.14,P<0.05).2. Analysis of KD group, IKD group of acute peripheral blood Th17and WBC,PLT, CRP, ESR, albumin, globulin, NT-PROBNP correlation.Group KD acute WBC(15.73±5.1),CRP(95.52±58.01),ESR(68.83±28.86),(34.77±3.51) of albumin, globulin (27.17±4.74),lg(NT-proBNP)(2.99±0.67).Group IKD acute WBC(14.58±6.63), CRP(63.84±50.32),ESR(59.73±34.17),(37.20±2.94)of albumin, globulin(28.63±3.71),lg(NT-proBNP)(2.35±0.83)3. Group KD, group IKD in acute stage and recovery stage, and the controlgroups, electrocardiogram and (or) ultrasound heartbeat graph group with theabnormal electrocardiogram and ultrasonic heartbeat graph in normal group,serum IL-17.The serum level of IL-17KD in acute stage was significantly higher thanthat in KD in remission and control group, and difference was significant(F=51.464, P<0.05); the serum level of IL-17IKD in acute stage wassignificantly higher than that in IKD in remission and control group,and thedifference was significant (F=57.357, P<0.05), KD, IKD in remission serum IL-17level between the control group and no significant (P<0.05); the serum IL-17levels in children with abnormal ultrasound heartbeat graph ultrasoundheartbeat graph is higher than that of normal children, and the difference wasstatistically significant (t=7.36,P<0.05).4. Analysis of KD group, IKD group, acute phase serum IL-17and WBC, CRP,ESR, albumin, globulin, NT-proBNP correlation. According to correlation analysis, the levels of IL-17in acute KD serumhad significant positive correlation with WBC, CRP, ESR, NT-proBNP and albumin(r=0.546、0.862、0.714、0.823、0.560, P<0.05), had significant negativecorrelation with globulin(r=-0.781, P<0.05).According to correlation analysis, the levels of IL-17in acute IKD serumhad significant positive correlation with WBC, CRP, ESR, NT-proBNP and albumin(r=0.698、0.826、0.648、0.886、0.769, P<0.05), had significant negativecorrelation with globulin(r=-0.702, P<0.05).5.The percentage of peripheral blood Th17cells in acute KD had positivecorrelation with serum levels of IL-17(r=0.854,P<0.05); The percentage ofperipheral blood Th17cells in acute IKD had positive correlation with serumlevels of IL-17(r=0.868,P<0.05)。CONCLUSION:The positive rate of serum IL-17levels, peripheral blood Th17cells wereincreased in KD, IKD children in acute phase, and Th17cells and the serumlevel of IL-17is one of KD activity index; Th17cell positive rate of serumlevel of IL-17in peripheral blood of children with ultrasound heartbeat graphof anomalies were higher than that of children with ultrasound heartbeat graphof normal, and Th17cells and serum the level of IL-17are associated withcardiovascular damage.

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