抗心磷脂抗体IgM在川崎病患儿恢复期冠状动脉病变中的诊断价值

Diagnostic Values of Anticardiolipin Antibodies Immunoglobulin M for Coronary Artery Lesion in Convalescence of Kawasaki Disease in Children

目的探讨抗心磷脂抗体IgM(ACA-IgM)在川崎病(KD)患儿恢复期冠状动脉病变(CAL)中的诊断价值。方法 31例KD患儿在予阿司匹林和(或)静脉用丙种球蛋白治疗2周后测定其ACA-IgM,并同时行二维超声心动图(2-DE)和64排螺旋CT(64-RSCT)冠状动脉造影。以64-RSCT冠状动脉造影为金标准,评价ACA-IgM、ACA-IgM联合2-DE诊断小儿KD恢复期CAL的敏感性、特异性和准确性。结果 11例(35.5%)KD患儿ACA-IgM阳性。64-RSCT冠状动脉造影显示13例(41.9%)有CAL,其中8例(61.5%)ACA-IgM阳性;64-RSCT冠状动脉造影18例(58.1%)正常,其中3例(16.7%)ACA-IgM阳性。ACA-IgM、2-DE、ACA-IgM+2-DE平行试验、ACA-IgM+2-DE系列试验和肌酸激酶同工酶(CK-MB)检出CAL的敏感性、特异性、阳性预测值、阴性预测值和准确性有明显差异,但其Youden指数无明显差异(U=0.167～1.852,P>0.05);ACA-IgM检出CAL的特异性与2-DE法相同,均为83.3%;但其敏感性(61.5%)、阳性预测值(72.7%)、阴性预测值(75.0%)和准确性(74.2%)低于2-DE法(84.6%,78.6%,88.2%,83.9%)。ACA-IgM+2-DE平行试验的敏感性(92.3%)提高,但特异性(72.2%)下降,ACA-IgM+2-DE系列试验的特异性(94.4%)提高,但敏感性(53.8%)下降,这2种方法检出CAL的准确性(80.6%,77.4%)虽较ACA-IgM测定有所提高,但仍低于2-DE法。结论 ACA-IgM诊断小儿KD恢复期CAL的特异性与2-DE法相同,但敏感性不高,联合2-DE法亦不能同时提高其敏感性和特异性。

Objective To explore the diagnostic vatues of anticardiolipin antibodies IgM （ ACA - IgM） detection for coronary artery lesion （CAL） in convalescence of Kawasaki disease （KD） in children. Methods After 2 weeks of asprin and（or） intravenous gamma globulin administration in 31 children with KD,the serum levels of ACA - IgM were detected,the two dimensional echocardiography （2 - DE） and the 64 - row spiral computed tomography （ 64 - RSCT） coronary angiography were performed. The results of 64 - RSCT coronary angiography were served as the golden criteria for the diagnosis of CAL in children with KD. The sensitivity,the specificity,and the accuracy of the ACA - IgM detection,the ACA - IgM detection combined with 2 - DE methods for the diagnosis of CAL in convalescence of KD were evaluated. Results Eleven children （35.5%） with KD had positive ACA - IgM. Thirteen children （41.9%） with KD had CAL in 64 - RSCT coronary angiography,of whom 8 children （61.5%） had positive ACA - IgM. Eighteen children （58.1%） with KD had no CAL in 64 - RSCT coronary angiography,of whom 3 children （16.7%） had positive ACA- IgM. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of diagnosing CAL had significant differences among the ACA - IgM detection ,2 - DE methods, the ACA - IgM detection combined with 2 - DE parallel test, the ACA - IgM detection combined with 2 - DE serial test, and the creatine phos- phate kinase - MB detection ; however, the Youden index of those methods had no difference （ U = 0. 167 - 1. 852 ,P 〉 0.05 ）. The specificity of ACA - IgM detection for the diagnosis of CAL was the same as that of 2 - DE methods （83.3%） ,but the sensitivity （61.5%） ,the positive predictive value （72.7%） ,the negative predictive value （75.0%）, and the accuracy （74.2%） of the ACA - IgM detection were lower than those of 2 - DE methods （84.6% ,78.6% ,88.2% ,83.9% ）. Compared with the ACA - IgM detection ,the sensitivity （92.3%） of the ACA - IgM detection combined with 2 - DE parallel test increased,but their specificity （72.2%） decreased;and also, the specificity （94.4%） of the ACA - IgM detection combined with 2 - DE serial test increased, however,their sensitivity （53.8%） decreased. Though the accuracy of the parallel test （80.6%） and the serial test （77.4%） increased compared with the ACA -IgM detection,it was still lower than that of 2 - DE methods. Conclusions The specificity of the ACA - IgM detection for the diagnosis of CAL in convalescence of KD in children was the same as that of 2 -DE methods;but the sensitivity of the ACA -IgM detection was lower,and the sensitivity and the specificity of the ACA - IgM detection combined with the 2- DE methods couldn＇t be increased simultaneously.