Objective To explore the clinical value of detecting T cell subsets,immunoglobulin(Ig) ,erythro-cyte sedimentation rate(ESR),C-reactive protein(CRP) in patients with juvenile rheumatoid arthritis(JRA). Meth-ods T cell subsets(CD3+ , CD4+ , CD8+ , CD16+CD56+) was detected with flow cytometer, Ig, CRP with rate nephelome-try,ESR with Westergren's method in 40 cases of JRA,and other 40 normal children were served as normal control group. Results The level of CD3+ ,CD8+ ,CD16+CD56+ in the JRA group were lower,but CD4+ was higher than those in normal control group(P< 0.05 all) ;the level of IgA, IgG, IgM, ESR, CRP in the JRA group were all higher than those in the normal control group( P < 0.05 ). Conclusion There is an inflammation in patients with JRA, and when disease activity there is an immunological aberrance with cellular and humoral immunization.

Objective To observe the changing levels of serum sFas before and after intravenous i mmunoglobulin (IVIG) treatment of incomplete Kawasaki disease (IKD),to explore the roles of sFas in the pathogenesis of IKD and IVIG treatment mechanism.Methods Thirty eight cases of IKD children were selected as experimental group and 20 examples of the same age of children as the control group.The IKD children were treated by IVIG in combination with aspirin (ASP) ; and blood test was performed before treatment,3 days after treatment,and 14 days after treatment,respectively.Dual-resistant sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum sFas,plasma Fibrinogen (PT-D),d-dimer (D-D),and c-reactive protein (CRP).Results The levels of serum sFas,PT-D,D-D,and CRP were significantly higher than the control group for IKD children before treatment[(0.55 ± 0.14)ng/L vs (0.24 ±0.04) ng/L,(552.3 ± 147.2) mg/dl vs (277.3 ±82.5)mg/dl,(649.0 ±201.6) μg/L vs (315.4 ±91.8)μg/L,and(72.2 ±28.7)mg/L vs (7.2 ±2.9)mg/L; t' =12.41,9.11,8.64,13.82;All P ＜ 0.05] ;3 days after treatment,compared with those before treatment and control group,the sFas level of IKD children at the third day after treatment was significantly decreased compared to that before treatment and control groups,respectively [(0.43 ± 0.09) ng/L vs (0.55 ± 0.14) ng/L,(0.24 ± 0.04) ng/L,F =47.624,All P ＜0.05] ;For the level of sFas at the 14th day after treatment,no statistical significance was found between IKD children and the control group[(0.24 ±0.05) ng/L vs (0.24 ±0.04) ng/L,t =0.596,P ＞ 0.05].Conclusions The abnormally increased serum sFas level before IVIG treatment suggests that dysfunction of apoptosis be involved in the pathogenesis of the IKD.Intravenous immunoglobulin treatment may be involved in the apoptosis process.

Objective To explore the effect of recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein injection (rhTNFR:FC) on the expression of cartilage oligomeric matrix protein (COMP) in the synovial fluid and peripheral blood of juvenile idiopathic arthritis (JIA); and to explore the clinical significance of COMP for JIA and the relationship between rhTNFR:FC and COMP in JIA.Methods Thirty-five patients with JIA (JIA group),30 patients with traumatic arthritis (trauma group) and 30 patients with indirect inguinal hernia hernioplasty (normal group) were included.Peripheral blood from all enrolled patients and synovial fluid from 15 JIA and 10 trauma arthritis were obtained for COMP detection before the treatment.Fifteen JIA (group A) patients were treated with combined rhTNFR:FC,diseasemodifying antirheumatic drugs (DMARDs) and non-steroid anti-inflammatory drugs (NSAIDs),20 JIA (group B) were treated with combined DMARDs and NSAIDs.After three to six months' treatment and when the disease were in remission,peripheral blood from group A and B were drawn for COMP detection.In group A,the synovial fluid from 5 patients were obtained for COMP detection after treatment.At the same time,such as tender joint count (TJC),swollen joint count (SJC),time for morning stiffness,blood routine,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) and other parameters before and after treatment were measured.The level of COMP was tested by double antibody sandwich enzyme-linked immunosorbent assay.The measurement data were tested for variance and independent sample t-test; and the enumeration data were tested by chi-squared or Fisher's exact test.Pearson's correlation analysis was adopted to analyze the association among the variables.Results ① The blood COMP level before treatment was (0.77±0.29) ng/ml in the JIA group,(1.00±0.28) ng/ml in the traumatic arthritis group,and (1.33±0.37) ng/ml in the normal control group.The level in the former two groups was obviously lower than that in the normal control group.The variation was statistically significant (F=25.345,P＜0.05).The comparison between any two groups was statistically significant (P＜0.05).② The COMP level in the synovial fluid before treatment were (14.8±1.6) ng/ml in the JIA group,(15.1±1.0) ng/ml in the traumatic arthritis group.The variation was not stati-stically significant (t=0.523,P=0.606).③ The serum COMP level of the systemic JIA group was obviously lower than that of the oligoarticular JIA patients,and patients with enthesitis-related arthritis and polyarticular JIA (0.26± 0.03 vs.0.87±0.17,0.89±0.22 and 0.70±0.35 ng/ml,respectively; F=9.244,P＜0.05).④ The serum COMP level of JIA at the acute phase was negatively correlated with white blood cells count (WBC),CRP and ESR (r=-0.556,-0.582 and-0.684,respectively; P all＜0.05).By contrast,no correlation was detected between the serum COMP level and joint tenderness index,joint swelling index,morning stiffness duration,hemoglobin level and platelet count(r=0.06,-0.206,-0.107,0.15 and-0.185,respectively; P all ＞0.05).⑤ The serum COMP level was obviously lower in the JIA with joint destruction than that without joint destruction (0.52±0.22 vs.0.92±0.22 ng/ml; t=5.207,P＜0.05).⑥After treatment,the blood COMP level in group A was (1.33±0.21) ng/ml and (0.96±0.22) ng/ml in group B,which was obviously higher than that in the JIA group before treatment (0.77±0.29) ng/ml.In addition,the level in group A was higher than that in group B.The variation was statistically significant (F=24.681,P＜0.05).⑦ After treatment,the COMP level in the synovial fluid (18.4± 1.1) ng/ml (n=5) was higher than that before the treatment was (14.8± 1.6) ng/ml (n =15).The variation was of statistical significant (t=4.565,P＜0.05).Conclusion The COMP level in blood and synovial fluid declines before treatment and increases after treatment.The increase is more obvious after combined with rhTNFR:FC treatment.The serum COMP level is remarkably decreased in JIA at the acute phase,systemic JIA,and the JIA with destruction of joint,and showes a negative correlation with WBC,CRP and ESR.Serum COMP may be a useful marker of active disease,destruction of joint and growth inhibition for patients with JIA.rhTNFR:FC treatment for JIA can facilitate the recovery of COMP.

Objectives To explore the change of interleukin-17 (IL-17) in Kawasaki disease (KD). Methods Fourty KD pediatric patients, among them 12 patients with echocardiographic abnormalities in acute phase, 25 age-matched non-KD patients were enrolled. The level of serum IL-17 was measured by enzyme linked immunosorbent assay in acute and convalescent phase of KD patients and non-KD patients. At the same time, C-reactive protein (CRP), globulin, albumin were detected. Results In acute phase of KD patients, the level of serum IL-17 were signiifcantly higher than that in convalescent phase of KD patients and non-KD patients (P<0.05). The level of serum IL-17 was no signiifcant differences in convalescent phase of KD patients and non-KD patients (P>0.05). In acute phase of KD patients with echocardiography abnormalities, the level of serum IL-17 was signiifcantly higher than that with non-echocardiography abnormalities (P<0.05). The level of serum IL-17 in acute phase of KD patients were positively correlated with CRP and globulin (r=0.750, 0.750, P<0.05), and negatively correlated with albumin (r=-0.779, P<0.05). Conclusions IL-17 may be involved in KD immune pathogenesis. Serum IL-17 is one of the activity index of KD, which associ-ated with cardiovascular damages.

ObjectiveTo compare the levels of sFas in the sera among Kawasaki disease (KD),incomplete Kawasaki disease (IKD),and normal control groups,and to analyze the relationship of sFas with IKD children.MethodsA total of 32 cases of acute KD and acute IKD children,and 20 cases of the control children were selected,respectively.The levels of serum sFas among three groups were measured using ELISA kits.Each child among the three groups was examined by echocardiography.Results(1)The levels of serum sFas among the three groups were[ (0.54±0.20)ng/L in KD,(0.55±0.16)ng/L in IKD,and (0.24 ± 0.04) ng/L] in control group,respectively.The overall means of sFas in the KD and IKD groups were higher than the control group,and the differences were statistically significant( F=29.276,P＜0.05 ).(2)The levels of serum sFas among echocardiography abnormal and normal groups were[ (0.65±0.19) ng/L and (0.49±0.10)ng/L],respectively; and the difference between two groups were statistically significant ( t=3.139,P ＜ 0.05 ).ConclusionsThe expression levels of sFas in the peripheral serum of IKD children were increased,and there was a close association of overexpression of sFas with the cardiovascular damage in IKD children.

Objective To study the expression levels of N-terminal pro-brain natriuretic peptide (NT-proBNP),serum albumin of Kawasaki' s disease (KD),incomplete Kawasaki' s disease (IKD),and children whose fever were unexplained and to explore the clinical significance of the levels of NT-proBNP and serum albumin in the early diagnosis of IKD.Methods The levels of NT-proBNP of 246 cases of KD (KD group),61 cases of IKD (IKD group) and 301 cases of children with unexplained fever (fever group)were measured by the enzyme-linked fluorescence analysis (ELFA) at the day of admission,meanwhile,the levels of albumin were tested in KD,and IKD children were underwent ECG and echocardiography.Based on the test results,patients were further divided into the group with cardiovascular damage and the group without cardiovascular damage.SPSS 19.0 was used for statistical analysis.The t test was used to compare the parameters between each group,the variance analysis and association analysis were carried out with Pearson's correlation analysis.The ROC curve analysis was done to identify the cardiovascular damage threshold.Results ① The level of plasma NT-proBNP of the KD group,the IKD group was significantly h igher than the fever group [(789.1±4.7) ng/L,(824.8±4.4) ng/L vs (92.5±2.3) ng/L,F=230.736,all P＜0.05];② The level of albumin of the KD group and the IKD group was significantly lower than that of the fever group [(33.9±2.8) g/L,(33.8±3.1) g/L vs (40.8±3.6) g/L,F=355.648,all P＜0.05]; ③ The levels of NT-proBNPs between the cardiovascular damage group and the groups without cardiovascular damage among the KD group,and those of the IKD groups were compared.In the KD group,the NT-proBNPs level of the two subgroups was (2948±3) g/L (n=103) vs (305±3) g/L,n=143; while in the IKD group,the NT-proBNPs of the two subgroups was (1454±4) g/L (n=38) vs (323±4) g/L (n=23).The dif-ferences were statistically significant (t=16.464,4.356,all P＜0.05).④ The plasma NT-proBNP level higher than 933.5 ng/L was identify as the indicator for cardiovascular damage in both KD and IKD children.Its sensi-tivity was 88.1％,and its specificity was 89％.⑤ When the level of NT-proBNP was higher than 250 ng/L,the sensitivity for diagnosis in the KD,the IKD was 80.9％,85.2％ respec-tively,and the specificity was 85.7％.When the level of NT-proBNP was higher than 250 ng/L and that of albumin was lower than 35 g/L,the sensitivity for diagnosis of KD,IKD was 67.5％,70.5％ respectively,the specificity was 99.7％.Conclusion The level of plasma NT-proBNP (＞250 ng/L) accompanied by decreased albumin (＜35 g/L) may be specific markers for early diagnosis of IKD.In addition,the level of NT-proBNP ≥933.5 ng/L can be used as a diagnostic threshold,which has good sensitivity and specificity for identifica-tion of cardiovascular damage in the KD and IKD in children.

Objective To explore the correlation between the distribution of uric acid (UA) level and the biochemical indicators which reflect the degree of organ lesions among hospitalized children.Methods Patients who were hospitalized to the Department of Pediatrics and received the blood UA test from June 2012 to October 2013 were included,23 217 cases in total.The biochemical analyzer-Japan's Olympus AU 2700 was used to detect blood biochemistry; and uricase-peroxidase coupling method was used to detect blood UA.Among these patients,2 099 cases whose UA level exceeded the normal level.Then the patients' gender,age,primary diagnosis and UA level were recorded; and the distribution of their UA level was described.The Chi-square or Fisher test was used to assess the incidence rate.At the same time,each blood biochemical indicators of the patients with high UA level were recorded ; and the relationships between the blood UA of the 1 650 patients with complete records and each blood biochemical indicator were analyzed with Pearson correlation analysis.Results The incidence rate of hyperuricemia among the hospitalized children was 9.04％(2 099/23 217).In particular,the incidence rate among boys and girls was 6.5t％(890/13 657) and 12.65％ (1 209/9 560) respectively (x2 =256.9,P＜0.05).The incidence rate of hyperuricemiin different diseases was as follows:in the critical illness 36.93％ (113/306),neonatal disease 20.34％ (922/4 533),urinary system diseases 12.08％ (47/389),circulatory system diseases 11.67％ (21/180),nervous system diseases 11.05％(112/1 014),digestive diseases 10.50％(190/1 810),infectious diseases 10.18％(120/1 179),blood diseases 7.58％ (55/726),endocrine system diseases 5.74％ (17/296),autoimmune diseases 4.24％ (48/1 131),respiratory diseases 3.90％ (454/11 653) respectively (x2=1423.0,P＜0.05).The incidence of hyperuricemia at younger than one month was 18.31％(929/5 075),younger than one year old was 4.22％ (359/8 501),younger than six years old was 10.68％(600/5 618),younger than 15 years old was 5.24％ (211/4 023) respectively (x2=858.5,P＜0.05).Blood UA was positively correlated to urea nitrogen,creatinine,lacticdehydrogenase,α-hydroxy-butyrate dehydrogenase,creatine kinase and creatine kinase-MB (r=0.426,0.44,0.324,0.367,0.413,0.431,P＜0.05).Blood UA was not correlated to fructosamine,blood glucose,triglycerides,total cholesterol,low-density lipoprotein and high density lipoprotein.Conclusion The incidence of hyper-uricemia among hospitalized children is high; and the incidence among children with severe diseases and newborn babies is high; followed by in children with urinary system and circulatory system diseases.The blood UA level is closely related to the blood biochemical indicators which reflect the lesions of heart and kidney.

Objective To observe the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP),high density lipoprotein cholesterol (HDL-C) in predicting cardiovascular damage in Kawasaki disease (KD).Methods Enzyme-linked fluorescence analysis (ELFA) technique was used to measure serum NT-proBNP levels in 406 KD patients [including 104 cases of incomplete Kawasaki disease (IKD)] at the acute phase,the convalescent stage,at the same time,the blood HDL-C,Albumin,globulin,alanine aminotransferase (ALT),C-reactive protein (CRP),red blood cell sedimentation rate (ESR),blood white cell count (WBC),hemoglobin (Hb),blood platelet count (PLT) level were tested.According to the results of echocardiography,electrocardiogram,myocardial enzymes in KD,patients were divided into two groups:two hundred and twenty-two with cardiovascular damage and 184 without cardiovascular damage group.The age,gender,fever,the first application of the intravenous gamma globulin,laboratory markers of clinical features observed above the detection levels were compared,and these parameters for each group were compared using t test or analysis of variance,the single factor which was statistically significant were received operating characteristic curve (ROC) analysis.Then the cardiovascular damage group was divided into echocardiography abnormal group and echocardiography normal group,and t test was adopted to compare the clinical parameters of the two groups.Results ① The age,lip and oral changes,the first application of intravenous gamma globulin,blood NT-proBNP,HDL-C,albumn and ALT was significantly different between the cardiovascular damage group and non cardiovascular damage group (t/x22=4.989,4.721,6.212,18.834,12.788,4.851,4.541,All P＜0.05).② When the blood NT-pro-BNP was higher than 786.5 ng/L,its sensitivity and specificity for differentiating KD with cardiovascular damage was 86.5％ and 84.8％,respectively.When the blood HDL-C was lower than 0.655 mmol/L,its sensitivity and specificity for differentiating KD with cardiovascular damage was 80.4％ and 69.4％ respectively.When the blood NT-proBNP was higher than 786.5 ng/L in addition to HDL-C lower than 0.655 mmol/L,the specificity for differentiating KD with cardiovascular damage was 91.8％.③ For the 222 cases with cardiovascular dam-age,their blood NT-proBNP,HDL-C levels were statistically significantly different between the echocardiogra-phy abnormal group and echocardiography normal group (t=3.354,4.084,All P＜0.05).④ The serum NT-proBNP,ALT levels of the 406 acute and convalescent KD patients were significantly higher than the recovery phase.The blood HDL-C,albumin level of acute patients were significantly lower than those at the recovery phase,the difference was statistically significant (t=22.335,4.951,20.334,15.073,All P＜0.05).⑤ One hundred and four children with IKD were divided into patients with cardiovascular damage (74 cases) and without cardiovascu-lar damage (30 cases),the age,lip and oral changes,the first application of intravenous gamma globulin,blood NT-proBNP,HDL-C,albumin and ALT were significantly differentbetween these two groups (t=3.083,2.157,6.423,6.409,3.649,8.658,All P＜0.05).Conclusion Blood NT-proBNP and HDL-C are good pre-dictive parameters in children with cardiovascular damage of KD,IKD.

Objective To explore the significance of interleukin (IL)-1β and IL-6 in serum of children with hyperuricemia (HUA). Methods 142 children including 71 children with HUA (HUA group) and 71 control children (control group), healthy and inguinal hernia children were selected as control group. 71 HUA children were subdivided into GA (gout attacks) group (n=28) and NGA (non-gout attacks) group (n=43) according to whether they had a history of acute gout attacks, including sudden monoarthritis of rapid onset with intense pain and swelling or without. Enzyme-linked immunosorbent assay was used to measure the level of IL-1β and IL-6 in serum. Results Serum IL-1β and IL-6 levels of HUA children were significantly higher than those of control group (all P<0.05). Serum IL-1β and IL-6 levels of HUA children in GA group were significantly higher than those of NGA group (P<0.05). Serum IL-1β and IL-6 levels of GA group in acute phase was significantly higher than those of HUA children in remission stage、NGA group and control group (P<0.05). Serum IL-1β and IL-6 levels of GA group in remission stage and NGA group was significantly higher than those of control group (P<0.05). There were no significant differences between HUA children in remission stage and NGA group (P>0.05). The serum IL-1β and IL-6 levels of HUA children were positively correlated with WBC, neutrophils, monocytes, uric acid, ESR, CRP, BUN and Cr (all P<0.05), while not correlated with triglyceride, total cholesterol, LDL-C and HDL-C(all P<0.05). Conclusion IL-1β and IL-6 play an important role in the pathogenesis of HUA in children.

Objective To explore the effect of Fas, Fas ligand (FasL), soluble Fas (sFas) and their clinical significance in KD. Methods The expression of Fas, FasL in peripheral blood lymphocytes (PBLC) were detected with flow cytometery at acute and remission stages in patients with KD; and the serums Fas was detected by double antibody sandwich ELISA in the patients with KD at acute and remission stage, meanwhile erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were also tested. Results The expression of Fas, FasL in PBLC in patients with KD at acute stage was (14.2±0.5)% and (1.61±0.09)% respectively , which were significantly lower than those at remission stage [(15.7±0.5)%, (1.95±0.09)% respectively (P<0.05 and P<0.01)]. The expression of Fas in PBLC in the patients with KD at acute and remission stage was both significantly lower than that in normal control group (20.8±0.5)% (P<0.01 both);The expression of FasL in PBLC in patients with KD at acute and remission stage was both significantly lower than that in normal control group (20.8±0.5)% (P<0.01 both); the serum sFas in patients with KD at acute and remission stage was (1906±55)μg/L and (1622±52)μg/L respectively , which was significantly higher than that in normal control group (1151±51)μg/L (P<0.01 both); the serum sFas at acute stage was obviously higher than that at remission stage (P<0.01); there was positive correlation between sFas and ESR, CRP (P<0.01 both). Conclusion There are abnormal expressions of Fas/FasL in PBLC and sFas in patients with KD. Fas/FasL is lower and sFas is higher than that of the controls. The abnormal expression of Fas/ FasL in lymphocytes and the apoptosis triggered by sFas are probably involved in the immunological aberrance and pathogenesis of KD. sFas may be used as a marker to evaluate the disease activity and therapeutic efficacy.