CAJ | 학술논문

目的研究血浆脑利钠肽(brain natriuretic peptide,BNP)在川崎病(Kawasaki disease,KD)患儿中的变化及其与心功能的关系,探讨其在KD诊断中的临床应用价值.方法前瞻性观察2007年2月至2009年4月间青岛市儿童医院心血管组收治的KD患儿43例(KD组),年龄5个月至8岁,平均(2.3±0.6)岁,均符合KD诊断标准,且除外心肌炎、心肌病、先天性心脏病等原发心脏疾病.对照组为30例健康体检儿童,年龄及性别与KD组比较差异无统计学意义(P>0.05).KD组于急性期、恢复期各采血1次,健康对照组随机采血1次,采用酶联免疫吸附法(ELISA)测定血浆BNP浓度,KD组常规超声心动图检测左室射血分数(left verdricular ejection fraction,LVEF)、左室短轴缩短率(left Yentrietdar shorten fraction,LVSF)、心脏指数(cardiac index,CI)及舒张期二尖瓣口血流频谱E/A比值.组间比较采用成组t检验,组内比较采用配对t检验,相关分析采用直线相关分析法,以P<0.05为差异具有统计学意义.结果 KD患儿急性期BNP水平为(517.26±213.40),ng/mL,恢复期为(91.56±47.97)ng/mL,两期比较差异具有统计学意义(P<0.01);急性期BNP水平亦明显高于健康对照组[(37.55±7.56)ng/mL],两组比较差异具有统计学意义(P<0.01);心功能参数LVEF,LVSF,CI急性期低于恢复期,两期比较差异均具有统计学意义(P<0.05),E/A比值两期比较差异无统计学意义(P>0.05);KD患儿急性期血浆BNP水平与反应心脏收缩功能指标LVEF,LVSF,CI均呈负相关(P<0.05),而与舒张功能E/A无明显相关性(P>0.05).结论 KD急性期血浆BNP浓度异常升高,心脏收缩功能下降,两者呈负相关.血浆BNP浓度检测对川崎病的早期诊断具有重要意义.
목적 연구혈장뇌리납태(brain natriuretic peptide,BNP)재천기병(Kawasaki disease,KD)환인중적변화급기여심공능적관계,탐토기재KD진단중적림상응용개치.방법 전첨성관찰2007년2월지2009년4월간청도시인동의원심혈관조수치적KD환인43례(KD조),년령5개월지8세,평균(2.3±0.6)세,균부합KD진단표준,차제외심기염、심기병、선천성심장병등원발심장질병.대조조위30례건강체검인동,년령급성별여KD조비교차이무통계학의의(P>0.05).KD조우급성기、회복기각채혈1차,건강대조조수궤채혈1차,채용매련면역흡부법(ELISA)측정혈장BNP농도,KD조상규초성심동도검측좌실사혈분수(left verdricular ejection fraction,LVEF)、좌실단축축단솔(left Yentrietdar shorten fraction,LVSF)、심장지수(cardiac index,CI)급서장기이첨판구혈류빈보E/A비치.조간비교채용성조t검험,조내비교채용배대t검험,상관분석채용직선상관분석법,이P<0.05위차이구유통계학의의.결과 KD환인급성기BNP수평위(517.26±213.40),ng/mL,회복기위(91.56±47.97)ng/mL,량기비교차이구유통계학의의(P<0.01);급성기BNP수평역명현고우건강대조조[(37.55±7.56)ng/mL],량조비교차이구유통계학의의(P<0.01);심공능삼수LVEF,LVSF,CI급성기저우회복기,량기비교차이균구유통계학의의(P<0.05),E/A비치량기비교차이무통계학의의(P>0.05);KD환인급성기혈장BNP수평여반응심장수축공능지표LVEF,LVSF,CI균정부상관(P<0.05),이여서장공능E/A무명현상관성(P>0.05).결론 KD급성기혈장BNP농도이상승고,심장수축공능하강,량자정부상관.혈장BNP농도검측대천기병적조기진단구유중요의의.
Objective To study the serum levels of brain natriuretic peptide (BNP) and the correlation with the heart function in children with Kawasaki disease(KD), and to explore its clinical value for diagnosis of KD. Method A total of 43 children aged from 5 months to 8 years with mean age of (2.3 + 0.6) years with KD admitted from February 2007 to April 2009 were enrolled into this study as KD group, and patients with myocarditis, myocardiopathy, congenital heart disease and other primary heart disease were ruled out. Another 30 healthy children were taken as control health group. There were no significant differences in age and gender between two groups (P >0.05) .The serum levels of BNP were measured both in acute and recovery stages of KD by using ELISA. The serum levels of BNP in healthy children were measured randomly once. The left ventricular ejection fraction (LVEF), left ventricular shorten fraction ( LVSF), cardiac index (CI) and left ventricular inflow velocity through the mitral annulus (including E-velocity and A-velocity) were measured by using two-dimensional echocardiography in acute and recovery stages of KD. Data were analyzed with t -test and the linear regression analysis test. Results The serum level of BNP in acute stage was (517.26 + 213.40) ng/mL and was significantly higher than that in recovery stage (91.56 + 47.97) ng/mL, and higher than that in control group (91.56 + 47.97) ng/mL (P < 0.01). The levels of LVEF, LVSF and CI in the acute stage were significantly lower than those in the recoverystage ( P < 0.0%), but there was no significant difference in E/A between acute stage and recovery stage (P > 0.05). The BNP level had negative correlation with the levels of LVEF, LVSF and CI(r = -0.63, -0.52, and - 0.53, respectively, P < 0.05), but had no significant correlation with E/A (r = - 0.18, P > 0.05). Conclusions The serum levels of BNP increase significantly in the KD patients, and have negative correlation with the levels of LVEF, LVSF and CI. The detection of serum levels of BNP has an important significance for diagnosis of KD.