Serum Levels of IL-17 and IL-23 and Their Prognostic Value in Children with Kawasaki Disease without Propyl Bulb React

JIAO Lihua; LIU Jianli; HONG Yuan; LIU Yin

doi:10.12102/j.issn.1672-1349.2025.09.020

Abstract：Objective: To investigate the changes in serum interleukin (IL)-17 and IL-23 levels in children with IVIG-nonresponsive Kawasaki disease and their predictive value for prognosis. Methods: A total of 84 children with IVIG-nonresponsive Kawasaki disease were selected as the observation group, and 84 children with Kawasaki disease who responded effectively to intravenous immunoglobulin (IVIG) treatment were selected as control group I. Additionally, 84 healthy children undergoing physical examination were selected as control group II. Serum IL-17 and IL-23 levels, left coronary artery (LCA)-Z values, and right coronary artery (RCA)-Z values were compared among the groups. Pearson correlation coefficient analysis was used to evaluate the relationship between serum IL-17 and IL-23 levels and LCA-Z and RCA-Z values in the observation group. A multivariate logistic regression model was applied to identify independent risk factors for coronary artery lesions in IVIG-nonresponsive Kawasaki disease patients. Restricted cubic spline plots were used to analyze the dose-response relationship between serum IL-17 and IL-23 levels and coronary artery lesions. The receiver operating characteristic (ROC) curve was used to assess the predictive value of serum IL-17 and IL-23 levels for coronary artery lesions. Results: Serum IL-17 and IL-23 levels, as well as LCA-Z and RCA-Z values, were higher in the observation group compared to control group I and control group II. In control group I, serum IL-17 and IL-23 levels, as well as LCA-Z and RCA-Z values, were higher than those in control group II (P < 0.05). In the observation group, serum IL-17 (r values of 0.853 and 0.848, P < 0.001) and IL-23 (r values of 0.840 and 0.826, P < 0.001) levels showed a positive correlation with LCA-Z and RCA-Z values. Patients with coronary artery lesions had higher serum IL-17, IL-23 levels, and LCA-Z and RCA-Z values compared to those without coronary artery lesions (P < 0.05). Elevated serum IL-17 and IL-23 levels, platelet count, and disease duration ≥4 days were independent risk factors for coronary artery lesions in IVIG-nonresponsive Kawasaki disease patients (P < 0.05). The area under the curve (AUC) for combined assessment of serum IL-17 and IL-23 levels in predicting coronary artery lesions was 0.884, which was higher than that of IL-17 (Z=2.339, P=0.019) or IL-23 (Z=2.835, P=0.005) alone. When serum IL-17 level >33.00 ng/mL and serum IL-23 level >35.00 ng/mL, the risk of coronary artery lesions in IVIG-nonresponsive Kawasaki disease patients significantly increased. Conclusion: Changes in serum IL-17 and IL-23 levels are closely related to coronary artery lesions in IVIG-nonresponsive Kawasaki disease patients. When serum IL-17 >33.00 ng/mL and IL-23 >35.00 ng/mL, the risk of coronary artery lesions significantly increases. Measuring these two levels can provide reference for clinical prediction of coronary artery lesions.