摘要： 目的：探究小儿川崎病（KD）肠道菌群变化与特异性转录因子RAR相关孤儿受体γt（RORγt）、叉头蛋白P3（FOXP3）、T淋巴细胞亚群水平的关联性。方法：选取本院2018年1月至2020年6月KD患儿110例，根据是否合并感染分为单纯KD组（68例）与KD合并感染组（42例），另选择同期健康儿童42例作为对照组。比较3组肠道菌群、RORγt、FOXP3、T淋巴细胞亚群变化情况，分析肠道菌群、RORγt、FOXP3、T淋巴细胞亚群与KD合并感染的关系，Pearson相关性分析肠道菌群与RORγt、FOXP3、T淋巴细胞亚群相关性，采用受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）评价肠道菌群、RORγt、FOXP3、T淋巴细胞亚群对KD合并感染的预测价值。结果：KD合并感染组乳酸杆菌属、韦荣球菌属、梭菌属、FOXP3、CD3+、CD4+/CD8+低于单纯KD组、对照组，单纯KD组低于对照组，拟杆菌属、肠球菌属、副杆菌属、RORγt高于单纯KD组、对照组，单纯KD组高于对照组（P<0.05）；Logistic回归分析，乳酸杆菌属、韦荣球菌属、梭菌属、RORγt、FOXP3、CD3+、CD4+/CD8+是KD、KD合并感染的重要保护因素，拟杆菌属、肠球菌属、副杆菌属是KD、KD合并感染的重要危险因素（P<0.05）；Pearson相关性分析，乳酸杆菌属、韦荣球菌属、梭菌属与RORγt呈负相关，与FOXP3、CD3+、CD4+/CD8+呈正相关，拟杆菌属、肠球菌属、副杆菌属与RORγt呈正相关，与FOXP3、CD3+、CD4+/CD8+呈负相关（P<0.05）；ROC曲线显示，肠道菌群、RORγt、FOXP3、T淋巴细胞亚群联合预测KD合并感染AUC为0.888，95%CI为0.822～0.953，P<0.001，预测敏感度为76.19%，特异度为89.71%，优于各指标单一预测。 结论：KD患儿肠道菌群变化与RORγt、FOXP3、T淋巴细胞亚群显著相关，且均与KD、KD合并感染联系紧密，联合检测可作为预测感染的重要手段。

T淋巴细胞亚群

Abstract: AIM: To explore the relationship between the changes of intestinal flora in children with Kawasaki disease (KD) and the specific transcription factor Rar related orphan receptor γt (RORγt), Fork head box P3 (FOXP3), and T lymphocyte subsets.  METHODS: A total of 110 children with KD in our hospital from January 2018 to June 2020 were selected and divided into simple KD group (68 cases) and KD co-infection group (42 cases) according to whether they were co-infected, and 42 healthy children during the same period were selected as the control group. The changes of the three groups of intestinal flora, RORγt, FOXP3, and T lymphocyte subsets were compared, and the relationship between the intestinal flora, RORγt, FOXP3, T lymphocyte subsets and KD co-infection was analyzed. Pearson correlation was used to analyze the correlation between the intestinal flora and RORγt, FOXP3, and T lymphocyte subsets.The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to evaluate the predictive value of intestinal flora, RORγt, FOXP3, and T lymphocyte subsets for KD co-infection. RESULTS: Lactobacillus, Veillonococcus, Clostridium, FOXP3, CD3+, CD4+/CD8+ in the KD co-infection group were lower than those in the simple KD group and the control group, the simple KD group was lower than the control group. The Bacteroides, Enterococcus, Parabacter, and RORγt were higher than the simple KD group and the control group, and the simple KD group was higher than the control group (P<0.05). Logistic regression analysis showed that Lactobacillus, Veillonococcus, Clostridium, RORγt, FOXP3, CD3+, CD4+/CD8+ were important protective factors for KD and KD co-infection, Bacteroides, Enterococcus, and Parabacter were important risk factors for KD and KD co-infection (P<0.05). Pearson correlation analysis showed that Lactobacillus, Veillonococcus and Clostridium were negatively correlated with RORγt, and positively correlated with FOXP3, CD3+, CD4+/CD8+. Bacteroides, Enterococcus, and Parabacterium were positively correlated with RORγt, and negatively correlated with FOXP3, CD3+, CD4+/CD8+ (P<0.05). The ROC curve showed that the AUC of KD co-infection predicted by the combination of intestinal flora, RORγt, FOXP3, and T lymphocyte subsets was 0.888. The 95% CI was 0.822-0.953, P<0.001, the prediction sensitivity was 76.19%, and the specificity was 89.71%, which was better than the single prediction of each index. CONCLUSION: The changes of intestinal flora in children with KD are significantly related to RORγt, FOXP3, and T lymphocyte subsets, and are closely related to KD and KD co-infections. Combined detection can be an important means to predict infection.

Key words: Kawasaki disease in children, intestinal flora, RORγt, FOXP3, T lymphocyte subsets

宣妙燕, 徐震. 小儿川崎病肠道菌群变化与特异性转录因子RORγt、FOXP3、T淋巴细胞亚群水平的关联性#br#[J]. 中国临床药理学与治疗学, 2021, 26(2): 154-160.

XUAN Miaoyan, XU Zhen. Correlation between changes of intestinal flora in children with Kawasaki disease and the levels of specific transcription factors RORγt, FOXP3 and T lymphocyte subsets[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2021, 26(2): 154-160.

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