血清氨基末端脑钠肽对川崎病冠状动脉病变预测价值的研究

目的探讨氨基末端脑钠肽(n-terminal brain natriuretic peptide,NT-BNP)在预测川崎病患儿冠状动脉损害中的作用。方法确诊为川崎病的患儿102例,根据超声结果分为冠状动脉病变组和冠状动脉无病变组,对其年龄、发热天数、血白细胞计数、白蛋白、ESR、CRP、谷丙转氨酶及血清NT-BNP水平等资料进行比较,并行ROC曲线分析。结果 102例川崎病患儿合并冠脉扩张者25例(24.5%),无扩张者77例(75.5%)。两组患儿间年龄、发热时间、血清白蛋白、谷丙转氨酶及NT-BNP水平差异有显著性意义,ROC曲线分析显示,血清NT-BNP水平有较高诊断价值,其次为发热时间,而年龄、血清白蛋白及谷丙转氨酶水平诊断的准确性较差。结论川崎病患儿血清NT-BNP在预测川崎病冠脉扩张中有良好的诊断价值,当血清NT-BNP水平<827pg/ml时,出现冠脉损害的可能性较小(阴性预测值0.93)。

Prediction of the Risk of Coronary Arterial Lesions in Kawasaki Disease by N-terminal Brain Natriuretic Peptide

Objective To investigate the role of N-terminal brain natriuretic peptide(NT-BNP)in the predicting of coronary arterial lesions in Kawasaki disease.Methods Totally 102 children with kawasaki disease were collected.All the children were divided into two groups by the results of echocardiogram of coronary artery.One group were of children with coronary artery lesions(CAL+) and another group were of no coronary artery lesions(CAL-).The parameters studied were sex,age,duration of fever,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),albumine,serum sodium levels,alanine aminotransferase(ALT) and brain natriuretic peptide(NT-BNP).These were examined with univariate analysis and receiver operating characteristic curves(ROCs) and areas under the curve(AUCs) were calculated.Results Among the 102 cases,the complication of coronary artery lesions was 25(24.5%).Univariate analysis indicated that age,the duration of fever,the level of albumine,ALT and NT-BNP had significant differences between the two groups(P<0.05).ROCs analysis indicated that the serum level of NT-proBNP was considered to be the best single predictor to identify the patients with KD who were likely to develop coronary artery lesions(CAL).Conclusion The serum NT-proBNP before IVIG was increased in KD children who later developed CAL compared to those who were not complicated by CAL.When the serum level of NT-BNP<827pg/ml,the risk of developing CAL was low(negative predictive value is 0.93).