Study On The Changes Of Cytokines And Their Correlation With Coagulation Indexes In Patients With Systemic Juvenile Idiopathic Arthritis

Objectives:To compare the difference of cytokines and coagulation indexes between patients with systemic juvenile idiopathic arthritis(SJIA)and polyarticular idiopathic arthritis(PJIA),To explore the correlation between cytokines and coagulation indexes,and to monitor the changes of cytokines and coagulation indexes after treatment.Methods:Collects the Kunming Medical college attached first hospital department of pediatrics diagnosis childhood especially to send the arthritis JIA patient 43 examples from January 1,2019 to March(31),2021,in which male 19 examples,the feminine 24 examples,the age 3～14 years old,average age 9.11 ±3.27 year old.According to international rheumatism association alliance(ILAR)2001 classified standard[1],the patients were divided into SJIA group(n=21)and PJIA group(n=22).After diagnosis,patients in the SJIA group were treated with tocilizumab after routine use of non-steroidal anti-inflammatory drugs and antirheumatic drugs to improve the disease.The levels of cytokines were detected by flow cytometry and the French STA-R automatic coagulation analyzer was used to detect the level of blood coagulation indexes.The levels of cytokines,including IL(Interleukin,IL)-2,IL-4,IL-6,IL-10,tumor necrosis factor-α(TNF-α),interferon-y(IFN-γ),coagulation indexes,including platelet count(PLT),fibrinogen(FIB),D-dimer,fibrin degradation products(FDP),thrombin time(TT),prothrombin time(PT),activation partial thrombokinase time(APTT)and inflammatory indexes,including white blood cell(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(E SR)and serum ferritin(SF)were compared between the two groups before treatment.Then the correlation between cytokines and coagulation indexes was analyzed,and the changes of cytokines,coagulation indexes,inflammatory indexes and SF in SJIA group before and after targeted treatment with tocilizumab were compared.SPSS22.0 statistical software was used for analysis.The difference was statistically significant(P<0.05).Results:1.Analysis of related laboratory indexes of patients in SJIA group and PJIA group before treatment:1.1 Comparison of cytokines between SJIA group and PJIA group before treatment:The SJIA group white blood cell lies between the element-6 levels obviously to be higher than PJIA group(P<0.05),but two groups of between white blood cells lie between the IL-2,IL-4,IL-10,TNF-α,and IFN-γ between the two groups(P>0.05).1.2 Comparison of coagulation indexes between SJIA group and PJIA group before treatment:the level of D-dimer in SJIA group was significantly higher than that in PJIA group(P<0.05),but there was no significant difference in PLT,FDP,FIB,PT,TT and APTT between the two groups(P>0.05).1.3 Comparison of inflammatory indexes and SF between SJIA group and PJIA group before treatment:CRP,ESR and SF in SJIA group were significantly higher than those in PJIA group(P<0.05),but two group of white blood cell non-significance difference(P>0.05).2.Analysis of related laboratory indexes before and after treatment in SJIA group:2.1 Changes of IL-6 in SJIA group before and after treatment:The serum IL-6 level of 21 patients in SJIA group treated with tocilizumab showed a downward trend after treatment,Compares with the morbidity before,after treats 6 weeks to drop obviously,the difference has statistics significance(P<0.05).After treats 12 weeks,the blood serum IL-6 level falls to the normal range.2.2 Changes of D-dimer in SJIA group before and after treatment:The serum D-dimer level of 21 patients in SJIA group treated with tocilizumab showed a downward trend after treatment,Compares with the morbidity before,after treats 6 weeks to drop obviously,the difference has statistics significance(P<0.05).After treats 12 weeks,the blood serum D-dimer level falls to the normal range.2.3 Changes of CRP and ESR in SJIA group before and after treatment:The serum CRP and ESR levels of 21 patients in SJIA group treated with tocilizumab showed a downward trend after drug treatment,and decreased significantly after 2 weeks of treatment compared with those before onset,and the difference was statistically significant(P<0.05).3.Correlation analysis of IL-6 and D-dimer in SJIA group:statistics of 21 patients in SJIA group treated with tocilizumab showed that there was a positive correlation between IL-6 and D-dimer before treatment and 2 weeks,4 weeks,6 weeks,8 weeks,10 weeks and 12 weeks after treatment(P<0.05).Conclusions:1.Before the treatment SJIA group blood serum IL-6,the D-dimer level is higher than the PJIA group obviously,prompts the SJIA group inflammatory response and congeals the condition to compare the PJIA group high to be obvious;The SJIA group after accepts holds past Shan Kang to treat 6 weeks,blood serum IL-6,the D-dimer level obviously reduces,prompts the treatment to be effective;After treats 12 weeks,blood serum IL-6,the D-dimer water may restore normally equally.2.The level of IL-6 in SJIA group was positively correlated with the change of D-dimer,and the hypercoagulable state is related to IL-6.3.Tocilizumab can improve the hypercoagulable state of SJIA patients by targeting inhibition of IL-6.4.In SJIA group,serum CRP and ESR levels could be down-regulated 2 weeks after treatment with tocilizumab.