N端脑钠肽前体在早期预测川崎病冠状动脉病变中的意义
N단뇌납태전체재조기예측천기병관상동맥병변중적의의
Prediction of the risk of coronary arterial lesions in Kawasaki disease by N-terminal pro-brain natriuretic peptide
  • 万方数据
    中华儿科杂志 중화인과잡지
    Chinese Journal of Pediatrics
    2015年 4期 300-303 ,共4页

    卢慧玲%刘亚萍%胡秀芬

    로혜령%류아평%호수분

    粘膜皮肤淋巴结综合征%冠状血管%预测 粘膜皮膚淋巴結綜閤徵%冠狀血管%預測
    점막피부림파결종합정%관상혈관%예측
    Mucocutaneous lymph node syndrome%Coronary vessels%Forecasting
    目的 观察急性期川崎病(KD)患儿血浆N端脑利钠肽前体(NT-proBNP)的变化及其与冠状动脉损害(CAL)高危因素的相关性,探讨血NT-proBNP早期预测CAL的临床意义.方法 选取2012年1月至2013年4月在华中科技大学同济医学院附属同济医院儿科住院的急性期KD患儿106例为研究对象,男64例,女42例,年龄2个月～8岁4个月.其中典型川崎病(TKD)患儿48例,不典型川崎病(IKD)患儿58例.根据冠状动脉与主动脉瓣环比值分为KD-CAL组(33例)及KD-无CAL(nCAL)组(73例).选取同期住院的感染发热患儿40例为对照组,其中男22例,女18例;年龄7个月～7岁11个月.应用酶联荧光分析(ELFA)技术测定患儿入院当天血浆NT-proBNP水平,同时检测血白细胞、中性粒细胞比例、血小板、C反应蛋白(CRP)、红细胞沉降率(ESR)、白蛋白及血钠水平.比较川崎病患儿血浆NT-proBNP水平的变化,并对NT-proBNP值进行受试者工作特征曲线(ROC)分析,获得预测CAL的最佳临界值.采用Pearson相关分析,探讨NT-proBNP与其他生化指标间的相关性.结果 TKD组血浆NT-proBNP水平为(1 037±271)ng/L,IKD组为(1 325±264) ng/L,对照组为(125 ±22) ng/L,TKD及IKD组血浆NT-proBNP水平均明显高于对照组,差异有统计学意义(t=3.360、3.590,P均＜0.05).KD-CAL组患儿血浆NT-proBNP水平为(2 775±842) ng/L,KD-nCAL组为(830±145) ng/L.KD-nCAL组患儿血浆NT-proBNP水平明显高于对照组,差异有统计学意义(t=3.660,P=0.007).KD-CAL组患儿血浆NT-proBNP水平明显高于KD-nCAL组,差异有统计学意义(t=3.860,P=0.005).KD-nCAL组患儿急性期白细胞、中性粒细胞比例、血小板、CRP、ESR均显著高于对照组,差异有统计学意义(P均＜0.05);而白蛋白及血钠显著低于对照组(P＜0.05).KD患儿血NT-proBNP与白细胞计数、中性粒细胞比例、CRP均成正相关(r=0.239,P=0.025;r=0.359,P=0.001;r=0.474,P=0.001),与白蛋白、血钠水平均成负相关(r=-0.303,P=0.015;r=-0.338,P=0.002).当血浆NT-proBNP水平为950 ng/L时,判断KD患儿是否存在心血管损害的敏感度为88.1％,特异度为89.0％.结论 血浆NT-proBNP水平升高可作为早期KD的特异性指标,有利于协助KD的早期诊断,并可早期预测CAL.
    목적 관찰급성기천기병(KD)환인혈장N단뇌리납태전체(NT-proBNP)적변화급기여관상동맥손해(CAL)고위인소적상관성,탐토혈NT-proBNP조기예측CAL적림상의의.방법 선취2012년1월지2013년4월재화중과기대학동제의학원부속동제의원인과주원적급성기KD환인106례위연구대상,남64례,녀42례,년령2개월～8세4개월.기중전형천기병(TKD)환인48례,불전형천기병(IKD)환인58례.근거관상동맥여주동맥판배비치분위KD-CAL조(33례)급KD-무CAL(nCAL)조(73례).선취동기주원적감염발열환인40례위대조조,기중남22례,녀18례;년령7개월～7세11개월.응용매련형광분석(ELFA)기술측정환인입원당천혈장NT-proBNP수평,동시검측혈백세포、중성립세포비례、혈소판、C반응단백(CRP)、홍세포침강솔(ESR)、백단백급혈납수평.비교천기병환인혈장NT-proBNP수평적변화,병대NT-proBNP치진행수시자공작특정곡선(ROC)분석,획득예측CAL적최가림계치.채용Pearson상관분석,탐토NT-proBNP여기타생화지표간적상관성.결과 TKD조혈장NT-proBNP수평위(1 037±271)ng/L,IKD조위(1 325±264) ng/L,대조조위(125 ±22) ng/L,TKD급IKD조혈장NT-proBNP수평균명현고우대조조,차이유통계학의의(t=3.360、3.590,P균＜0.05).KD-CAL조환인혈장NT-proBNP수평위(2 775±842) ng/L,KD-nCAL조위(830±145) ng/L.KD-nCAL조환인혈장NT-proBNP수평명현고우대조조,차이유통계학의의(t=3.660,P=0.007).KD-CAL조환인혈장NT-proBNP수평명현고우KD-nCAL조,차이유통계학의의(t=3.860,P=0.005).KD-nCAL조환인급성기백세포、중성립세포비례、혈소판、CRP、ESR균현저고우대조조,차이유통계학의의(P균＜0.05);이백단백급혈납현저저우대조조(P＜0.05).KD환인혈NT-proBNP여백세포계수、중성립세포비례、CRP균성정상관(r=0.239,P=0.025;r=0.359,P=0.001;r=0.474,P=0.001),여백단백、혈납수평균성부상관(r=-0.303,P=0.015;r=-0.338,P=0.002).당혈장NT-proBNP수평위950 ng/L시,판단KD환인시부존재심혈관손해적민감도위88.1％,특이도위89.0％.결론 혈장NT-proBNP수평승고가작위조기KD적특이성지표,유리우협조KD적조기진단,병가조기예측CAL.
    Objective To detect plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in acute Kawasaki disease (KD) and analyze the relationship between NT-proBNP and other bio-markers in order to evaluate if NT-proBNP could be as a useful diagnostic marker to predict the risk of coronary arterial lesions in acute KD.Method Totally 106 patients with KD were recruited from January 2012 to April 2014 at Department of Pediatrics of Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,64 were boys and 42 were girls,their age ranged from 2 months to 8 years and 4 months.Of the 106 cases,48 had typical KD(TKD) and 58 incomplete KD(IKD).They were divided into two groups according to echocardiography results:coronary arterial lesions (KD-CAL,n =33) and non coronary arterial lesions (KD-nCAL,n =73).Forty children whose age and gender matched with respiratory tract infection were selected as control group,22 were boys and 18 were girls,age range from 7 months to 7 years and 11 months.Plasma NT-proBNP levels were measured by using the enzyme-linked fluorescence analysis (ELFA) at the day of admission,meanwhile blood routine tests,liver function tests,determination of C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),electrolytes were performed in these patients.Pearson's correlation analysis was used to evaluate the association.The ROC curve analysis was done to identify the threshold of coronary arterial lesions.Result The levels of NT-proBNP were (1 037 ± 271) ng/L in TKD group and (1 325 ±264) ng/L in IKD group.The levels of NT-proBNP in control group was (125 ±22) ng/L.Both the levels of NT-proBNP in TKD and IKD group were significantly higher than that of control group (t =3.360,3.590;P ＜ 0.05).The level of NT-proBNP in KD-CAL group was(2 775± 842) ng/L and that of KD-nCAL group was (830 ± 145) ng/L,NT-proBNP levels of KD-nCAL group was significantly higher than that of control group (t =3.660,P =0.007);moreover the level of NT-proBNP of KD-CAL group was also significantly higher than that of KD-nCAL group (t =3.860,P =0.005).The levels of total white blood cell count,neutrophil percentage,platelet count,CRP and ESR of KD-CAL group were significantly higher than those of the control group,however there was no significant difference between KD-CAL group and KD-nCAL group.The levels of albumin and Na of KD-nCAL group were significantly lower than those of the control group.Plasma NT-proBNP level in KD group was positively correlated with white blood cell count,neutrophil percentage,and CRP (r =0.239,P =0.025;r =0.359,P =0.001;r =0.474,P =0.001),there was a negative correlation between albumin and Na (r =-0.303,P =0.015;r =-0.338,P =0.002).When the level of NT-proBNP was higher than 950 ng/L,the sensitivity for diagnosis of coronary arterial lesions in the KD was 88.1％ and the specificity was 89.0％.Conclusion The plasma NT-proBNP can be used as a useful parameter in early diagnosis of KD.Plasma NT-proBNP could be used to predict the risk of coronary arterial lesions in KD.
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