| Objective To investigate the clinical significance of the detection of peripheral venous blood circulating endothelial cells(CECs)and endothelial microparticles(EMPs)in Kawasaki disease patients with not sensitive intravenous immunoglobulin(IVIG)type.Methods The first,collected 56 cases of Kawasaki disease patients in children during January 2016 to December 2019 in shenzhen futian district maternal and child health care hospital in pediatrics,in which 22 cases were selected for IVIG sensitive as sensitive group randomly,and 11 cases were selected for IVIG not sensitive as not sensitive group.The second,between the two groups in acute period,subacute period,recovery period,the total number of white blood cells(WBC),neutrophils(NEUT),hemoglobin(Hb),platelet count(PLT),C-reactive protein(CRP)and blood sedimentation(ESR),alanine aminotransferase(ALT)and albumin(ALB)in peripheral venous blood were detected,at the same time CECs was detected by using Percoll density gradient centrifugation,EMPs was measured by using flow cytometry.The third,used Heart color doppler to check the 11 patients of not sensitive group,and dynamic monitored which existing coronary artery expansion(CAE)or not.According to the results of coronary artery expansion,the 11 patients of not sensitive group were divided intocoronary artery lesions(CALs)group 6 cases and no coronary artery lesions(NCALs)5 cases.The fourth,two groups of patient were given IVIG 2 g/kg in one day,intravenous drip,drip 5 to 6 hours.At the same time,regularly used aspirin(30 to 50 mg/kg in one day)and gradually reduced,observed treatment in the process of the patient's clinical symptoms,thermal annealing time and coronary artery lesions.Results The first,Kawasaki disease between IVIG sensitive group and IVIG not sensitive group in acute stage of clinical features compared,including conjunctival congestion,oral congestion/chaps,strawberry tongue,polymorphous skin rashes,cervical lymph node enlargement,palmoplantar erythema/hard edema index,there was no significant different,no statistical significance(P >0.05).The second,Kawasaki disease between IVIG not sensitive group and IVIG sensitive group in acute stage,subacute stage,recovery laboratory index(WBC,NEUT,Hb,PLT,ESR,CRP,ALT,ALB)compared,the differences were no statistical significance(P >0.05).The third,IVIG not sensitive group in acute stage and subacute phase of CECs,EMPs levels were higher than these in IVIG sensitive group at the same time,and the differences were statistically significant(P<0.05);In recovery stage CECs,EMPs levels compared,the differences between the two groups were no statistical significance(P >0.05).The fourth,IVIG not sensitive group in acute stage,subacute stage,recovery stage of CECs,EMPs levels compared,the differences were statistically significant(P <0.05).The Spearman correlation coefficient analysis,Kawasaki disease with IVIG not sensitive group of CECs was positively related with EMPs(r=0.844,P =0.000).The fifth,11 cases in IVIG not sensitive group had 6 cases with CALs,including 3 cases appearing mild coronary artery expansion,3 casesappearing moderate coronary artery expansion,no coronary artery giant tumor cases.The sixth,Kawasaki disease with IVIG not sensitive group with CALs in acute stage and subacute stage about CECs,EMPs,heart coronary artery diameter(CAD)levels were higher than in NCALs group in the same period,the differences were statistically significant(P <0.05).From above to compare the differences between the two groups in recovery stage had no statistical significance(P >0.05).The Spearman correlation coefficient analysis,IVIG not sensitive group with CALs CECs was positively related with CAD(r=0.395,P <0.05),IVIG not sensitive group with CALs of EMPs was positively related with CAD(r=0.377,P <0.05).Conclusions The first,the levels of CECs and EMPs in Kawasaki disease with IVIG not sensitive type were higher than these in Kawasaki disease with sensitive IVIG type in the acute phage and the subacute phase.Considering peripheral venous blood CECs,EMPs testing may help to early predict kawasaki disease appearing IVIG not sensitive.The second,the levels of CECs and EMPs in Kawasaki disease with IVIG not sensitive group in different course are differences.Dynamic monitoring the levels of CECs,EMPs in different course in Kawasaki disease with IVIG not sensitive type may help to evaluate the curative effect.The third,early detection the levers of CECs,EMPs in patients of kawasaki disease with IVIG not sensitive type may help to early judge and predict the appearence of coronary artery lesions. |
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