激肽原1、精氨酸酶-1在川崎病患儿急性期外周血中的表达及临床意义

目的：检测急性期川崎病（Kawasaki disease，KD）患儿激肽原1（kininogen1，KNG1）、精氨酸酶-1（arginase-1，Arg-1）在外周血中的表达并探讨二者的临床意义。方法：选取深圳市儿童医院2020年12月1日至2022年12月30日确诊为川崎病患儿117例患儿进行研究。根据是否合并冠状动脉病变（coronary artery lesion，CAL）将川崎病患儿分为CAL组（n=53）和非冠状动脉病变组（non-coronary artery lesion，NCAL）组（n=64）。ELISA法检测急性期川崎病患儿外周血KNG1及Arg-1水平。应用二元Logistic回归分析和受试者工作特征（receiver operating characteristic curve，ROC）曲线分析急性期川崎病患儿合并CAL的危险因素及KNG1、Arg-1对其的预测价值。结果：CAL组的KNG1及Arg-1含量均高于NCAL组，差异有统计学意义（P<0.01）。多因素Logistic回归分析提示KNG1、Arg-1和中性粒细胞比例（N%）是KD并发CAL的独立危险因素。ROC分析显示，KNG1对CAL的最佳预测值为1.536 ng/mL，曲线下面积（AUC值）为0.823（95%CI 0.750~0.896），而Arg-1≥7.028 ng/mL可用于预测CAL的发生，曲线下面积为0.862（95%CI 0.792~0.931），N%对KD并发CAL的最佳预测值则为54.7%，曲线下面积为0.610（95%CI 0.507~0.712）。此外还发现与单项指标相比，KNG1联合Arg-1及N%对急性期川崎病患儿并发CAL的预测价值最大（AUC值为0.929，95%CI 0.881~0.977），灵敏度和特异度分别为84.9%和92.2%。结论：急性期川崎病患儿血清中高表达的KNG1和Arg-1均是发生CAL的独立危险因素，可能参与川崎病CAL的发生和发展。

Expression and Clinical Significance of Kininogen 1 and Arginase-1 in Peripheral Blood of Children with Acute Kawasaki Disease

Objective: To detect the expression of kininogen1 (KNG1) and arginase-1 (Arg-1) in peripheral blood of children with acute Kawasaki disease (KD), and to explore the clinical significance. Methods: A total of 117 children diagnosed with KD from Shenzhen Children’s Hospital from Dec. 1st, 2020 to Dec. 30th, 2022 were selected for the study. Children with KD were divided into the coronary artery lesion (CAL) group (n=53) and non-coronary artery lesion (NCAL) group (n=64) depending on CAL. Levels of KNG1 and Arg-1 in peripheral blood of children with acute KD were detected by enzyme-linked immunosorbent assay (ELISA). Binary Logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the risk factors of CAL and predictive value of KNG1 and Arg-1 in children with acute KD. Results: The contents of KNG1 and Arg-1 in CAL group were higher than those in NCAL group (Z/t=-7.25, -6.718, P<0.01). Multivariate Logistic regression analysis showed that KNG1, Arg-1 and proportion of neutrophils (N%) were independent risk factors for KD complicated with CAL. ROC analysis showed that the best predictive value of KNG1 for CAL was 1.536 ng/mL, the area under the curve (AUC) was 0.823 (95%CI from 0.750 to 0.896). Arg-1 ≥7.028 ng/mL could be used to predict the occurrence of CAL, the AUC was 0.862 (95%CI from 0.792 to 0.931). The best predictive value of N% for KD complicated with CAL was 54.7%, and the AUC was 0.610 (95%CI from 0.507 to 0.712). In addition, compared with single indicators, KNG1 combined with Arg-1 and N% had the greatest predictive value for CAL in children with acute KD (AUC=0.929, 95%CI from 0.881 to 0.977), and the sensitivity and specificity were 84.9% and 92.2%, respectively. Conclusion: High expression of KNG1 and Arg-1 in peripheral blood of children with acute KD are independent risk factors for CAL, which may be involved in the occurrence and development of KD complicated with CAL.