中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2014年
3期
170-175,后插1
,共7页
狄亚珍%吴菱%钟世玲%李蕴言%陈圆玲%戴霞华%林亚红
狄亞珍%吳蔆%鐘世玲%李蘊言%陳圓玲%戴霞華%林亞紅
적아진%오릉%종세령%리온언%진원령%대하화%림아홍
利钠肽,脑%脂蛋白类,HDL胆固醇%黏膜皮肤淋巴结综合征%心血管疾病
利鈉肽,腦%脂蛋白類,HDL膽固醇%黏膜皮膚淋巴結綜閤徵%心血管疾病
리납태,뇌%지단백류,HDL담고순%점막피부림파결종합정%심혈관질병
Natriuretic peptide,brain%Lipoproteins,HDL Cholesterol%Mucocutaneous lymph node syndrome%Cardiovascular diseases
目的 探讨血N末端脑利钠肽原(NT-proBNP)、HDL-C在预测川崎病心血管损害中的价值.方法 应用酶联荧光分析(ELFA)技术分别测定406例川崎病患儿[其中不完全川崎病(IKD)患儿104例]急性期、恢复期的血NT-proBNP水平,同时观察血HDL-C、白蛋白、球蛋白、ALT、CRP、ESR、白细胞计数、血红蛋白、血小板计数水平;再根据超声心动图、心电图、心肌酶谱结果将川崎病患儿分为心血管损害组222例及心血管无损害组184例,对2组患儿的年龄、性别、热程、首次应用静脉注射用丙种球蛋白时间、临床特征及以上检测的实验室指标水平进行比较,比较采用t检验或x2检验,对差异有统计学意义的单因素进行受试者工作特征曲线(ROC)分析;再将心血管损害组分为超声心动图异常组及超声心动图正常组,采用t检验比较2组的临床指标.结果 ①406例川崎病患儿中心血管损害组与心血管无损害组间年龄、唇及口腔改变、首次应用静脉丙种球蛋白时间、血NT-proBNP、HDL-C、白蛋白、ALT水平差异有统计学意义(t/x2=4.989、4.721、6.212、18.834、12.788、4.851、4.541,P均＜0.05).②当血NT-proBNP≥786.5ng/L时,鉴别川崎病患儿是否存在心血管损害的敏感性为86.5％,特异性为84.8％;当血HDL-C＜0.655mmol/L时,鉴别川崎病患儿是否存在心血管损害的敏感性为80.4％,特异性为69.4％;当同时满足血NT-proBNP≥786.5 ng/L及HDL-C＜0.655 mmol/L时鉴别川崎病患儿是否存在心血管损害的特异性为91.8％.③222例心血管损害的川崎病患儿中超声心动图异常组及超声心动图正常组间血NT-proBNP、HDL-C水平差异有统计学意义(t=3.354、4.084,P均＜0.05).④406例川崎病患儿急性期与恢复期实验室指标比较,血NT-proBNP、ALT水平急性期明显高于恢复期,血HDL-C、白蛋白水平急性期明显低于恢复期,差异有统计学意义(t=22.335、4.951、20.334、15.073,P均＜0.05).⑤将104例IKD患儿分为心血管损害组(74例)及心血管无损害组(30例),2组间年龄、首次应用静脉丙种球蛋白时间、血NT-proBNP、HDL-C、白蛋白、ALT水平差异有统计学意义(t=3.083、2.157、6.423、6.409、3.649、8.658,P均＜0.05).结论 血NT-proBNP及HDL-C在川崎病、IKD患儿心血管损害中有良好的预测价值.
目的 探討血N末耑腦利鈉肽原(NT-proBNP)、HDL-C在預測川崎病心血管損害中的價值.方法 應用酶聯熒光分析(ELFA)技術分彆測定406例川崎病患兒[其中不完全川崎病(IKD)患兒104例]急性期、恢複期的血NT-proBNP水平,同時觀察血HDL-C、白蛋白、毬蛋白、ALT、CRP、ESR、白細胞計數、血紅蛋白、血小闆計數水平;再根據超聲心動圖、心電圖、心肌酶譜結果將川崎病患兒分為心血管損害組222例及心血管無損害組184例,對2組患兒的年齡、性彆、熱程、首次應用靜脈註射用丙種毬蛋白時間、臨床特徵及以上檢測的實驗室指標水平進行比較,比較採用t檢驗或x2檢驗,對差異有統計學意義的單因素進行受試者工作特徵麯線(ROC)分析;再將心血管損害組分為超聲心動圖異常組及超聲心動圖正常組,採用t檢驗比較2組的臨床指標.結果 ①406例川崎病患兒中心血管損害組與心血管無損害組間年齡、脣及口腔改變、首次應用靜脈丙種毬蛋白時間、血NT-proBNP、HDL-C、白蛋白、ALT水平差異有統計學意義(t/x2=4.989、4.721、6.212、18.834、12.788、4.851、4.541,P均＜0.05).②噹血NT-proBNP≥786.5ng/L時,鑒彆川崎病患兒是否存在心血管損害的敏感性為86.5％,特異性為84.8％;噹血HDL-C＜0.655mmol/L時,鑒彆川崎病患兒是否存在心血管損害的敏感性為80.4％,特異性為69.4％;噹同時滿足血NT-proBNP≥786.5 ng/L及HDL-C＜0.655 mmol/L時鑒彆川崎病患兒是否存在心血管損害的特異性為91.8％.③222例心血管損害的川崎病患兒中超聲心動圖異常組及超聲心動圖正常組間血NT-proBNP、HDL-C水平差異有統計學意義(t=3.354、4.084,P均＜0.05).④406例川崎病患兒急性期與恢複期實驗室指標比較,血NT-proBNP、ALT水平急性期明顯高于恢複期,血HDL-C、白蛋白水平急性期明顯低于恢複期,差異有統計學意義(t=22.335、4.951、20.334、15.073,P均＜0.05).⑤將104例IKD患兒分為心血管損害組(74例)及心血管無損害組(30例),2組間年齡、首次應用靜脈丙種毬蛋白時間、血NT-proBNP、HDL-C、白蛋白、ALT水平差異有統計學意義(t=3.083、2.157、6.423、6.409、3.649、8.658,P均＜0.05).結論 血NT-proBNP及HDL-C在川崎病、IKD患兒心血管損害中有良好的預測價值.
목적 탐토혈N말단뇌리납태원(NT-proBNP)、HDL-C재예측천기병심혈관손해중적개치.방법 응용매련형광분석(ELFA)기술분별측정406례천기병환인[기중불완전천기병(IKD)환인104례]급성기、회복기적혈NT-proBNP수평,동시관찰혈HDL-C、백단백、구단백、ALT、CRP、ESR、백세포계수、혈홍단백、혈소판계수수평;재근거초성심동도、심전도、심기매보결과장천기병환인분위심혈관손해조222례급심혈관무손해조184례,대2조환인적년령、성별、열정、수차응용정맥주사용병충구단백시간、림상특정급이상검측적실험실지표수평진행비교,비교채용t검험혹x2검험,대차이유통계학의의적단인소진행수시자공작특정곡선(ROC)분석;재장심혈관손해조분위초성심동도이상조급초성심동도정상조,채용t검험비교2조적림상지표.결과 ①406례천기병환인중심혈관손해조여심혈관무손해조간년령、진급구강개변、수차응용정맥병충구단백시간、혈NT-proBNP、HDL-C、백단백、ALT수평차이유통계학의의(t/x2=4.989、4.721、6.212、18.834、12.788、4.851、4.541,P균＜0.05).②당혈NT-proBNP≥786.5ng/L시,감별천기병환인시부존재심혈관손해적민감성위86.5％,특이성위84.8％;당혈HDL-C＜0.655mmol/L시,감별천기병환인시부존재심혈관손해적민감성위80.4％,특이성위69.4％;당동시만족혈NT-proBNP≥786.5 ng/L급HDL-C＜0.655 mmol/L시감별천기병환인시부존재심혈관손해적특이성위91.8％.③222례심혈관손해적천기병환인중초성심동도이상조급초성심동도정상조간혈NT-proBNP、HDL-C수평차이유통계학의의(t=3.354、4.084,P균＜0.05).④406례천기병환인급성기여회복기실험실지표비교,혈NT-proBNP、ALT수평급성기명현고우회복기,혈HDL-C、백단백수평급성기명현저우회복기,차이유통계학의의(t=22.335、4.951、20.334、15.073,P균＜0.05).⑤장104례IKD환인분위심혈관손해조(74례)급심혈관무손해조(30례),2조간년령、수차응용정맥병충구단백시간、혈NT-proBNP、HDL-C、백단백、ALT수평차이유통계학의의(t=3.083、2.157、6.423、6.409、3.649、8.658,P균＜0.05).결론 혈NT-proBNP급HDL-C재천기병、IKD환인심혈관손해중유량호적예측개치.
Objective To observe the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP),high density lipoprotein cholesterol (HDL-C) in predicting cardiovascular damage in Kawasaki disease (KD).Methods Enzyme-linked fluorescence analysis (ELFA) technique was used to measure serum NT-proBNP levels in 406 KD patients [including 104 cases of incomplete Kawasaki disease (IKD)] at the acute phase,the convalescent stage,at the same time,the blood HDL-C,Albumin,globulin,alanine aminotransferase (ALT),C-reactive protein (CRP),red blood cell sedimentation rate (ESR),blood white cell count (WBC),hemoglobin (Hb),blood platelet count (PLT) level were tested.According to the results of echocardiography,electrocardiogram,myocardial enzymes in KD,patients were divided into two groups:two hundred and twenty-two with cardiovascular damage and 184 without cardiovascular damage group.The age,gender,fever,the first application of the intravenous gamma globulin,laboratory markers of clinical features observed above the detection levels were compared,and these parameters for each group were compared using t test or analysis of variance,the single factor which was statistically significant were received operating characteristic curve (ROC) analysis.Then the cardiovascular damage group was divided into echocardiography abnormal group and echocardiography normal group,and t test was adopted to compare the clinical parameters of the two groups.Results ① The age,lip and oral changes,the first application of intravenous gamma globulin,blood NT-proBNP,HDL-C,albumn and ALT was significantly different between the cardiovascular damage group and non cardiovascular damage group (t/x22=4.989,4.721,6.212,18.834,12.788,4.851,4.541,All P＜0.05).② When the blood NT-pro-BNP was higher than 786.5 ng/L,its sensitivity and specificity for differentiating KD with cardiovascular damage was 86.5％ and 84.8％,respectively.When the blood HDL-C was lower than 0.655 mmol/L,its sensitivity and specificity for differentiating KD with cardiovascular damage was 80.4％ and 69.4％ respectively.When the blood NT-proBNP was higher than 786.5 ng/L in addition to HDL-C lower than 0.655 mmol/L,the specificity for differentiating KD with cardiovascular damage was 91.8％.③ For the 222 cases with cardiovascular dam-age,their blood NT-proBNP,HDL-C levels were statistically significantly different between the echocardiogra-phy abnormal group and echocardiography normal group (t=3.354,4.084,All P＜0.05).④ The serum NT-proBNP,ALT levels of the 406 acute and convalescent KD patients were significantly higher than the recovery phase.The blood HDL-C,albumin level of acute patients were significantly lower than those at the recovery phase,the difference was statistically significant (t=22.335,4.951,20.334,15.073,All P＜0.05).⑤ One hundred and four children with IKD were divided into patients with cardiovascular damage (74 cases) and without cardiovascu-lar damage (30 cases),the age,lip and oral changes,the first application of intravenous gamma globulin,blood NT-proBNP,HDL-C,albumin and ALT were significantly differentbetween these two groups (t=3.083,2.157,6.423,6.409,3.649,8.658,All P＜0.05).Conclusion Blood NT-proBNP and HDL-C are good pre-dictive parameters in children with cardiovascular damage of KD,IKD.
