CAJ | 학술논문

目的观察川崎病、不完全川崎病(IKD)和发热原因不明患儿血浆N末端脑利钠肽原(NT-proBNP)、血清白蛋白的表达水平,探讨血NT-proBNP、白蛋白水平在早期诊断IKD中的临床意义.方法应用酶联荧光分析(ELFA)技术测定246例川崎病患儿(川崎病组)、61例IKD患儿(IKD组)及301例入院时发热原因不明患儿(发热组)人院当天血浆NT-proBNP水平,同时观察血白蛋白等水平.川崎病、IKD患儿行心电图及超声心动图检查,根据检查结果分心血管损害组及无心血管损害组.对各组间检测指标比较应用t检验或方差分析,各检测指标间关系用Pearson相关分析,对有统计学意义的NT-proBNP值进行受试者工作特征曲线(ROC)分析,获得鉴别心血管损害的最佳临界值.结果 ①川崎病组、IKD组血浆NT-proBNP水平明显高于发热组[(789.1±4.7)、(824.8±4.4)和(92.5±2.3) ng/L,F=230.736,P均＜0.05].②川崎病组、IKD组血白蛋白水平明显低于发热组[(33.9±2.8)、(33.8±3.1)和(40.8±3.6) g/L,F=355.648,P均＜0.05].③川崎病组、IKD组中心血管损害组与无心血管损害组血浆NT-proBNP水平比较,川崎病组:(2948±3) g/L(103例)和(307±3) g/L(143例)；IKD组:(1454±4) g/L(38例)和(323±4) g/L(23例)；差异均有统计学意义(t=16.464、4.356,P均＜0.05).④当血浆NT-proBNP水平≥933.5 ng/L时,鉴别川崎病、IKD患儿是否存在心血管损害的敏感性为88.1％,特异性为89％.⑤当血浆NT-proBNP＞250 ng/L时诊断川崎病、IKD的敏感性分别为80.9％、85.2％,特异性均为85.7％.当同时满足血浆NT-proBNP＞250 ng/L及血白蛋白＜35 g/L时诊断川崎病、IKD的敏感性分别为67.5％、70.5％,特异性均为99.7％.结论血浆NT-proBNP水平升高(＞250 ng/L)同时伴白蛋白下降(＜35 g/L)可能是早期诊断IKD的特异性指标,以血浆NT-proBNP≥933.5 ng/L作为诊断川崎病、IKD患儿心血管损害的临界值可较好地兼顾敏感性和特异性. 目的觀察川崎病、不完全川崎病(IKD)和髮熱原因不明患兒血漿N末耑腦利鈉肽原(NT-proBNP)、血清白蛋白的錶達水平,探討血NT-proBNP、白蛋白水平在早期診斷IKD中的臨床意義.方法應用酶聯熒光分析(ELFA)技術測定246例川崎病患兒(川崎病組)、61例IKD患兒(IKD組)及301例入院時髮熱原因不明患兒(髮熱組)人院噹天血漿NT-proBNP水平,同時觀察血白蛋白等水平.川崎病、IKD患兒行心電圖及超聲心動圖檢查,根據檢查結果分心血管損害組及無心血管損害組.對各組間檢測指標比較應用t檢驗或方差分析,各檢測指標間關繫用Pearson相關分析,對有統計學意義的NT-proBNP值進行受試者工作特徵麯線(ROC)分析,穫得鑒彆心血管損害的最佳臨界值.結果 ①川崎病組、IKD組血漿NT-proBNP水平明顯高于髮熱組[(789.1±4.7)、(824.8±4.4)和(92.5±2.3) ng/L,F=230.736,P均＜0.05].②川崎病組、IKD組血白蛋白水平明顯低于髮熱組[(33.9±2.8)、(33.8±3.1)和(40.8±3.6) g/L,F=355.648,P均＜0.05].③川崎病組、IKD組中心血管損害組與無心血管損害組血漿NT-proBNP水平比較,川崎病組:(2948±3) g/L(103例)和(307±3) g/L(143例)；IKD組:(1454±4) g/L(38例)和(323±4) g/L(23例)；差異均有統計學意義(t=16.464、4.356,P均＜0.05).④噹血漿NT-proBNP水平≥933.5 ng/L時,鑒彆川崎病、IKD患兒是否存在心血管損害的敏感性為88.1％,特異性為89％.⑤噹血漿NT-proBNP＞250 ng/L時診斷川崎病、IKD的敏感性分彆為80.9％、85.2％,特異性均為85.7％.噹同時滿足血漿NT-proBNP＞250 ng/L及血白蛋白＜35 g/L時診斷川崎病、IKD的敏感性分彆為67.5％、70.5％,特異性均為99.7％.結論血漿NT-proBNP水平升高(＞250 ng/L)同時伴白蛋白下降(＜35 g/L)可能是早期診斷IKD的特異性指標,以血漿NT-proBNP≥933.5 ng/L作為診斷川崎病、IKD患兒心血管損害的臨界值可較好地兼顧敏感性和特異性.
목적 관찰천기병、불완전천기병(IKD)화발열원인불명환인혈장N말단뇌리납태원(NT-proBNP)、혈청백단백적표체수평,탐토혈NT-proBNP、백단백수평재조기진단IKD중적림상의의.방법 응용매련형광분석(ELFA)기술측정246례천기병환인(천기병조)、61례IKD환인(IKD조)급301례입원시발열원인불명환인(발열조)인원당천혈장NT-proBNP수평,동시관찰혈백단백등수평.천기병、IKD환인행심전도급초성심동도검사,근거검사결과분심혈관손해조급무심혈관손해조.대각조간검측지표비교응용t검험혹방차분석,각검측지표간관계용Pearson상관분석,대유통계학의의적NT-proBNP치진행수시자공작특정곡선(ROC)분석,획득감별심혈관손해적최가림계치.결과 ①천기병조、IKD조혈장NT-proBNP수평명현고우발열조[(789.1±4.7)、(824.8±4.4)화(92.5±2.3) ng/L,F=230.736,P균＜0.05].②천기병조、IKD조혈백단백수평명현저우발열조[(33.9±2.8)、(33.8±3.1)화(40.8±3.6) g/L,F=355.648,P균＜0.05].③천기병조、IKD조중심혈관손해조여무심혈관손해조혈장NT-proBNP수평비교,천기병조:(2948±3) g/L(103례)화(307±3) g/L(143례)；IKD조:(1454±4) g/L(38례)화(323±4) g/L(23례)；차이균유통계학의의(t=16.464、4.356,P균＜0.05).④당혈장NT-proBNP수평≥933.5 ng/L시,감별천기병、IKD환인시부존재심혈관손해적민감성위88.1％,특이성위89％.⑤당혈장NT-proBNP＞250 ng/L시진단천기병、IKD적민감성분별위80.9％、85.2％,특이성균위85.7％.당동시만족혈장NT-proBNP＞250 ng/L급혈백단백＜35 g/L시진단천기병、IKD적민감성분별위67.5％、70.5％,특이성균위99.7％.결론 혈장NT-proBNP수평승고(＞250 ng/L)동시반백단백하강(＜35 g/L)가능시조기진단IKD적특이성지표,이혈장NT-proBNP≥933.5 ng/L작위진단천기병、IKD환인심혈관손해적림계치가교호지겸고민감성화특이성.
Objective To study the expression levels of N-terminal pro-brain natriuretic peptide (NT-proBNP),serum albumin of Kawasaki' s disease (KD),incomplete Kawasaki' s disease (IKD),and children whose fever were unexplained and to explore the clinical significance of the levels of NT-proBNP and serum albumin in the early diagnosis of IKD.Methods The levels of NT-proBNP of 246 cases of KD (KD group),61 cases of IKD (IKD group) and 301 cases of children with unexplained fever (fever group)were measured by the enzyme-linked fluorescence analysis (ELFA) at the day of admission,meanwhile,the levels of albumin were tested in KD,and IKD children were underwent ECG and echocardiography.Based on the test results,patients were further divided into the group with cardiovascular damage and the group without cardiovascular damage.SPSS 19.0 was used for statistical analysis.The t test was used to compare the parameters between each group,the variance analysis and association analysis were carried out with Pearson's correlation analysis.The ROC curve analysis was done to identify the cardiovascular damage threshold.Results ① The level of plasma NT-proBNP of the KD group,the IKD group was significantly h igher than the fever group [(789.1±4.7) ng/L,(824.8±4.4) ng/L vs (92.5±2.3) ng/L,F=230.736,all P＜0.05];② The level of albumin of the KD group and the IKD group was significantly lower than that of the fever group [(33.9±2.8) g/L,(33.8±3.1) g/L vs (40.8±3.6) g/L,F=355.648,all P＜0.05]; ③ The levels of NT-proBNPs between the cardiovascular damage group and the groups without cardiovascular damage among the KD group,and those of the IKD groups were compared.In the KD group,the NT-proBNPs level of the two subgroups was (2948±3) g/L (n=103) vs (305±3) g/L,n=143; while in the IKD group,the NT-proBNPs of the two subgroups was (1454±4) g/L (n=38) vs (323±4) g/L (n=23).The dif-ferences were statistically significant (t=16.464,4.356,all P＜0.05).④ The plasma NT-proBNP level higher than 933.5 ng/L was identify as the indicator for cardiovascular damage in both KD and IKD children.Its sensi-tivity was 88.1％,and its specificity was 89％.⑤ When the level of NT-proBNP was higher than 250 ng/L,the sensitivity for diagnosis in the KD,the IKD was 80.9％,85.2％ respec-tively,and the specificity was 85.7％.When the level of NT-proBNP was higher than 250 ng/L and that of albumin was lower than 35 g/L,the sensitivity for diagnosis of KD,IKD was 67.5％,70.5％ respectively,the specificity was 99.7％.Conclusion The level of plasma NT-proBNP (＞250 ng/L) accompanied by decreased albumin (＜35 g/L) may be specific markers for early diagnosis of IKD.In addition,the level of NT-proBNP ≥933.5 ng/L can be used as a diagnostic threshold,which has good sensitivity and specificity for identifica-tion of cardiovascular damage in the KD and IKD in children.