| Objective:1.Screen the laboratory indexes that can identify the occurrence of MAS early:once kids have been diagnosed with SJIA,we should vigilant the occurrence of MAS,besides,we should predict the development process of the disease early,so as to carry out early treatment for this serious complication in order to improve the prognosis of SJIA-MAS.2.To evaluate the significance of inflammatory cytokines in SJIA-MAS:study on the clinical significance of cytokines with inflammatory characteristics in evaluating the therapeutic effect of SJIA-MAS,in addition to those common evaluation indexes of disease outcome such as ferritin,ESR,PLT,FIB,AST and WBC.Methods:There were 8 children were diagnosed with SJIA-MAS initially as the experimental group(refer to the diagnostic criteria of SJIA combined with MAS which was proposed by Ravelli in 2005),and 14 children diagnosed with SJIA initially in Wuhan Children’s Hospital from December 2020 to December 2021 were collected as the control group(refer to the diagnostic criteria of SJIA which was proposed by ILRA in 2001).In the experimental group,there were 5 boys and 3 girls,with an average age of 6.10 years old and a median age of 5.65 years old,and the average length of hospital stay was 22.75 days and a median of 22.5 days;In the control group,there were 5 boys and 9 girls,with an average age of 8.09 years old and a median age of 7.05 years old,and the average length of hospital stay was 14.14 days and a median of 13 days.About 1-2ml of venous blood was collected before and after treatment,which was detected by ELISA of the serum level of NF-k B,IL-18,CXCL-9,s PD-1,s TNFRII,sTNFR-Ⅰ/Ⅱ;and some clinical data was recorded,such as IL-2,IL-4,IL-6,IL-10,TNF-αand IFN-γ.SPSS 26.0 software was used for statistical analysis,there were 22 patients divided into two groups according to the diagnostic criteria of SJIA-MAS and SJIA,and the measured data before and after treatment were recorded.These data were expressed as mean ± standard deviation(x ± s),the difference of measurement data was detected by paired sample t-test,the curative effect significance was analyzed by ROC curve.Results:1.Before treatment,the level of NF-kB,IL-18,sTNFR-Ⅰ/Ⅱ,TNF-α,IL-6 and CXCL-9 in the experimental group(SJIA-MAS)were significantly higher than those in the control group(SJIA);There was no significant difference in IFN-γ,IL-2,IL-4,IL-10,s TNFR-II and s PD-1 between two groups.The P values of these cytokines were:NF-k B(experimental group:T = 2.595,p = 0.036;control group: T = 2.459,p = 0.029);IL-18(experimental group: T =4.255,p = 0.004;control group: T = 3.129,p = 0.008);TNF-α(experimental group: T = 2.812,p = 0.026);IL-6(experimental group: T = 2.956,p = 0.021);CXCL-9(experimental group: T= 2.78,p = 0.027);STNFR-I/II(experimental group: T = 5.954,p = 0.001).2.According to the ROC curve:(1)STNFR-I/II and TNF-α have certain value for predicting whether SJIA will progress to MAS,and the area under ROC curve(AUC)is(0.759,0.67)respectively.In SJIA patients,sTNFR-Ⅰ/Ⅱ have the best predictive value of the early recognition of MAS,which predicted value(PV)is 1.37(pg/ml)(95% CI 0.551-0.967),and the sensitivity and specificity are 1 and 0.643 respectively.(2)TNF-α have a poor predictive value compared to sTNFR-Ⅰ/Ⅱ.(3)NF-k B,IL-18,IL-6 and CXCL-9 can’t predict whether SJIA will merge MAS,and the area under ROC curve(AUC)are(0.362,0.21,0.161 and 0.219)respectively.Conclusion:1.sTNFR-Ⅰ/Ⅱ,as the most sensitive index,can be used as a laboratory monitoring index to recognize the occurrence of MAS early in children with SJIA.2.NF-k B、IL-18、sTNFR-Ⅰ/Ⅱ、TNF-α、IL-6 and CXCL-9 can be used as indicators to evaluate the efficacy of SJIA-MAS in children. |
PDF Full Text Request