N端脑钠肽前体在川崎病患儿中的变化及意义

Change and significance of NT-proBNP in children with Kawasaki disease

目的探讨N末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)在川崎病(Kawasaki disease,KD)患儿中的变化及其临床意义。方法分别测定46例确诊为KD急性期的患儿血浆NT-proBNP水平,并测定了其应用IVIG后患儿血浆NT-proBNP水平,同时以15例小儿上呼吸道感染作为对照组,并检测其血浆NT-proBNP水平。分别测定KD患儿在急性期及恢复期的外周血白细胞计数、C反应蛋白及血浆心肌肌钙蛋白(cardiac troponin I,cTnI)水平,常规超声心动图检测血流及冠状动脉病变情况。结果 KD患儿急性期血NT-proBNP水平为(701.4±94.8)ng/L,而对照组小儿血浆中NT-proBNP水平为(58.9±15.1)ng/L,两组相比差异具有统计学意义(P=0.001)。KD病人血浆NT-proBNP应用IVIG前明显高于应用IVIG后,检测结果提示NT-proBNP水平与急性期患儿的心肌肌钙蛋白水平有关。结论血浆NT-proBNP水平在KD急性期显著升高,而在疾病恢复期其水平明显降低。KD患儿急性期血浆NT-proBNP水平的升高可能与急性期KD患儿的心肌炎症及炎性因子的升高有关。

Ojective To examine the value of NT-pro BNP in the diagnosis of KD and to explore the mechanism of the change in plasma NT-pro BNP in children with KD.Methods Forty-six patients,aged from 4 months to 75 months,with KD were enrolled and fifteen patients with acute upper respiratory infection were used as controls.Blood sample was obtained to measure plasma NT-pro BNP concentrations in the acute and convalescent phases of KD and in the acute phase of the control patients.Plasma NT-pro BNP was measured using enzyme immunoassay.Other laboratory data including complete blood cell count,C-reactive protein,ESR,etc,were also measured in acute phase in both groups.The serum cardiac troponin I was also detected in acute phase of children with KD.Two dimensional echocardiography was performed to check for coronary lesions of patients with KD.The correlation between plasma NT-pro BNP and the above parameters was analyzed.Results The mean plasma NT-pro BNP concentration in patients with KD in the acute phase was（701.4±94.8） ng/L,and it was（58.9 ±15.1） ng/L in patients of control group.The plasma NT-pro BNP in patients with KD in the acute phase was significantly higher than that of the control group（P=0.001）.In 46 cases of KD,the plasma NT-pro BNP concentrations were measured both in Pre-IVIG and Post-IVIG.The mean plasma NT-pro BNP concentration of KD in Pre-IVIG was（701.4±94.8） ng/L and it was（164±35） ng/L in Post-IVIG.Serum cTnI has the same change the control group.Conclusion The plasma NT-pro BNP concentration increased in the acute phase and decreased significantly in the convalescent phase of KD.The plasma NT-pro BNP might be one of the useful biological markers of KD,and the mechanism of change in plasma NT-pro BNP in KD might be associated with cardiac injury and inflammatory factors.