| 摘要: |
| 目的:探讨急性期川崎病(KD)患儿血浆N端脑利钠肽前体(NT-proBNP)和降钙素原(PCT)水平的变化对早期预测冠状动脉损害(CAL)的价值。方法:选取2016年3-10月湖南省儿童医院急救中心收治的99例KD患儿为研究对象,其中典型川崎病(TKD)患儿67例,不完全川崎病(IKD)患儿32例。根据心脏彩超检查结果有无冠状动脉损害将患儿分为KD-CAL组52例KD-nCAL组(不伴CAL)47例,选择同期同年龄段本院健康体检儿童28例作为对照组,测定血浆NT鄄proBNP和PCT水平,同时检测血常规、CRP、ESR、白蛋白、ALT、AST、血钠水平,比较KD患儿血浆NT-proBNP及PCT水平的变化,并对血浆NT-proBNP及PCT水平做受试者工作特征曲线(ROC)分析,获得预测CAL的最佳临界值。结果:急性期KD患儿血浆NT-proBNP水平为(1 711.78±649.69)ng/L,明显高于对照组的(346.23±138.35)ng/L,急性期KD患儿血浆PCT水平为0.98(1.05) ng/mL,高于对照组的0.35(0.46)ng/mL,差异均有统计学意义(P<0.01)。KD-CAL组血浆NT-proBNP水平为(2 607.66±757.58)ng/L,明显高于KD-nCAL组的(650.00±53.95)ng/L(t =2.294,P<0.05),KD-CAL组血浆PCT水平为1.79(2.10)ng/mL,高于KD-nCAL组的0.56(1.39)ng/mL(t=2.935,P<0.05)。血浆NT-proBNP和PCT水平预测KD患儿冠状动脉的ROC曲线下面积分别为0.750和0.721,当BNP≥565 ng/L时为最佳界值,判断KD患儿是否存在冠状动脉损害的敏感度、特异度分别为87.5%、66.7%;当PCT1 ng/mL时为最佳界值,敏感度、特异度分别为68.8%、70.4%。结论:NT-proBNP及PCT水平升高在KD早期预测CAL有重要的临床意义。 |
| 关键词: 川崎病 N端脑利钠肽前体 降钙素原 冠状动脉损害 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.09.001 |
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| 基金项目:国家科技支撑计划项目,编号2012BAI04B00。 |
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| Prediction of Plasma NT-proBNP and PCT for Early Kawasaki Disease Coronary Artery Lesions |
| Fan Jianghua, Duan Wei, Luo Haiyan, Yang Longgui, Tao Yan |
| (Hunan Children's Hospital, Hunan Changsha 410007, China) |
| Abstract: |
| Objective: To observe the changes of plasma N-terminal pro-brain natriuretic peptide ( NT-proBNP) and serum procalcitonin (PCT) in acute Kawasaki disease (KD), and to probe into the value of NT-proBNP and PCT for early Kawasaki disease coronary artery lesions. Methods: Ninety-nine children admitted into emergency center of Hunan Children’s Hospital from Mar. to Oct. 2016 were extracted as the research objectives, among which 67 cases were typical KD (TKD) and 32 cases were incomplete KD (IKD). All children were divided into KD-coronary arterial lesions (KD-CAL) group (n=52) and KD-non coronary arterial lesions (KD-nCAL) group (n=47) according to the ehocardiography results. Twenty-eight children with healthy physical examination in the same age group were selected as the control group, plasma NT-proBNP and PCT were measured, and serum levels of blood, CRP, ESR, albumin, ALT, and AST were determined. Changes of plasma NT-proBNP and PCT in children with Kawasaki disease were compared, and the receiver operating characteristic curve (ROC) of plasma NT-proBNP and PCT were analyzed to obtain the optimal threshold for predicting CAL. Results: The plasma NT-proBNP in children with acute KD was (1,711.78±649. 69) ng/L, which was significantly higher than that of the control group (346.23±138.35) ng/L. The plasma PCT of children with acute KD was 0.98 (1.05) ng/mL, significantly higher than the control group 0.35 (0.46) ng/mL, the difference was statistically significant (P<0.01). The plasma NT-proBNP in KD-CAL group was (2,607.66±757.58) ng/L, significantly higher than that in KD-nCAL group (650.00±53.95) ng/L (t =2.294, P<0.05); the plasma PCT of KD-CAL group was 1.79(2.10) ng/mL, significantly higher than that of KD-nCAL group 0.56(1.39) ng/mL (t =2.935, P<0.05), with statistically significant differences. Plasma NT-proBNP and PCT predicted the ROC area under the coronary artery curve of KD children were 0.750 and 0.721, respectively; when the level of NT-proBNP was higher than 565 ng/L, the sensitivity for diagnosis of CAL was 87.5% and the specificity was 66.7%; when the level of PCT was higher than 1 ng/mL, the sensitivity was 68.8% and the specificity was 70.4%. Conclusion: The levels of NT-proBNP and PCT have important clinical implications for early prediction of CAL in KD. |
| Key words: Kawasaki disease N-terminal pro-brain natriuretic peptide procalcitonin coronary arterial lesions |
