儿童均在2个月内未患感染性疾病，既往无反复呼吸道感染病史，无过敏史，无先天性心脏病、寄生虫病，无肿瘤、自身免疫性疾病，未使用激素和免疫抑制剂。经病史、体格检查、胸部X线片以及彩色多普勒超声心动图及常规生化检查未见异常各组在性别、年龄上均无明显差异（P＞0.05）。采用酶联免疫双抗体夹心（ELISA）法测定各组儿童血清中TNF-α、VEGF的水平。所得数据采用SPSS13.0统计软件进行数据分析，计量资料测定数值用X?S表示，采用t检验，取α=0.05有统计学意义，p＜0.05表示差异有统计学意义。 结果：
1.毛细支气管炎合并心力衰竭发作期患者治疗前血清TNF-α水平明显高于治疗后.差异具有统计学意义（t值为5.886，P＜0.05）。 2.毛细支气管炎合并心力衰竭发作期患者血清TNF-α浓度明显高于健康对照组。差异具有统计学意义（t值为5.01，P＜0.05） 3.毛细支气管炎合并心力衰竭发作期患者治疗前血清VEGF水平明显高于治疗后，差异具有统计学意义（t值为2.07，P＜0.05） 4.毛细支气管炎合并心力衰竭发作期患者血清VEGF浓度为明显高于健康对照组。差异具有统计学意义（t值为2.32，P＜0.05） 结论：
1．TNF-a是毛细支气管炎合并心力衰竭发生发展中的重要因子，今后有望成为毛细支气管炎合并心里衰竭的靶因子。
2．VEGF与毛细支气管炎的发病息息相关，其检测水平对于毛细支气管炎合并心力衰竭患者的血清检测具有重要意义。
3．毛细支气管炎合并心力衰竭患儿血清TNF-a和VEGF检测的研究表明两者呈正相关，可以为临床对于此类疾病的研究提供新的研究方向和诊断标准。
关键词： 毛细支气管炎，心力衰竭，TNF-α，VEGF
英文摘要
Objective：Capillary bronchitis is one of the infants and young children common lower respiratory infectious diseases,.It is mainly caused respiratory syncytial virus.It only restricted to infants and young children before the age of 2, frequently-occurring in baby six months ago. Children with capillary bronchitis is easy to cough repeatedly in half year after sicken.The disease often occurs in winter and spring season, the condition in more cough after 2-3 days gradually aggravate, shortness of breath and faster, accompanied by nasal fan and chest depression. The more serious condition can appear purple purple, for any serious when may merge heart failure.The clinical manifestations of the capillary bronchitis is different from other common infective inflammation. But clinical manifestations of asthma has many similarities with it, and higher incidence of asthma occurred after illness. At present, there is no precise research about the pathogenesis of the disease within our country and abroad .Therefore, the capillary bronchitis with heart failure in children for early treatment is particularly important, TNF and VEGF as
inflammatory mediators involved in the process of capillary bronchitis.Tumor necrosis factor (TNF) is a kind of protein produced by mononuclear macrophage system. It is an effective cancer killer factor and also is the important regulatory factor of the engine body's inflammatory and immune response. TNF alpha is released by respiratory epithelial cells, peripheral blood neutrophils, mononuclear macrophage, NK cells, T lymphocytes and B lymphocytes, eosinophils and vascular endothelial cells release.The role of TNF alpha are associated with the lever within tissue.low level of TNF alpha plays a positive role in tissue repair, inflammation response. A large release of TNF alpha may cause immune pathological injury of the organization.VEGF is vascular endothelial cells (endothlial cell, EC) specificity promote mitogen.It can promote the endothelial cell proliferation effectively, improve endothelia cells function, induce the formation of blood vessels and increase capillary permeability. VEGF is an extremely sensitive and specific indicator in diagnosis of early myocardial ischemia.VEGF levels increased significantly when the body is in a state of ischemia, hypoxia. It could promote the establishment of myocardial collateral circulation, increase myocardial blood supply. This paper mainly discusses the change of TNF alpha and VEGF in capillary bronchitis with heart failure patients’ serum before and after the treatment, and treatment and prognosis of clinical significance.
Methods：Selected randomly 66 research objects from January to December in 2014. The study involved patients who visited the people's liberation army 251 hospital pediatric outpatient and diagnosed with capillary bronchitis. It admitted within the age of 28 days, or more than 24 months , a diagnosis of capillary bronchitis, and admitted to hospital or merge heart failure diagnosis after admission.All the diagnosis criteria of research objects conform to the 7th edition of the practical pediatrics. And eliminate the respiratory system defects, congenital heart disease, bronchial pulmonary hypoplasia, toxic encephalopathy, the merger of course a convulsion in children, the unstable clinical condition , Parents quit treatment or transfer.There are 30 patients with capillary bronchitis merger heart failure In these research objects.The other randomly selected at the same time with the age group 20 cases of health children as control, the control of children are not suffering from infectious diseases in 2 months, without a history of recurrent respiratory tract infections, no history of allergies, congenital heart disease, parasitic disease, tumor and autoimmune diseases, not use hormone and immune inhibitors. They are normal in engine body by medical history, physical examination, chest X ray film and color Doppler cardiograph and conventional.Each group had no obvious difference in gender, age(P > 0.05).This study used enzyme-linked immune double antibodies sandwich (ELISA) method to detect the level of TNF alpha and VEGF in serum of patients.The data is
analyzed by SPSS13.0 statistical software. Determination of numerical measurement data is expressed by X?S,and it tested by t. alpha = 0.05, for significant boundaries. P 1.Capillary bronchitis in episodes with heart failure patients serum TNF-a levels were significantly higher than those after treatment. The difference is statistically significant (t =5.886, P < 0.05) 2. Episodes capillary bronchitis with heart failure patients serum VEGF concentration is significantly higher than the healthy control group . The =differences statistically significant (t =5,01, P < 0.05) 3.Capillary bronchitis in episodes with heart failure patients serum VEGF levels were significantly higher than those after treatment. The difference is statistically significant (t =2.07, P < 0.05) 4.Episodes capillary bronchitis with heart failure patients serum VEGF concentration is significantly higher than the healthy control group . The differences statistically significant. Conclusion： 1.TNF -a is an important factor in the development of capillary bronchitis with heart failure.It is expected to become the target factor of capillary bronchitis with heart failure. 2.VEGF is closely related to the onset of capillary bronchitis, its level of detection for the treatment of capillary bronchitis with heart failure