脑利钠肽在川崎病患儿中的变化及其临床意义

Clinical value of the change of brain natriuretic peptide in children with Kawasaki disease

目的:探讨脑利钠肽(brain natriuretia peptide,BNP)在川崎病(Kawasaki disease,KD)患儿中的变化及其临床意义。方法:选取36例确诊为KD的患儿为KD组,测定其急性期及恢复期的血浆BNP水平,选取36例上呼吸道感染的患儿为对照组,测定其血浆BNP水平。分别测定两组患儿外周血白细胞数(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)及血浆心肌肌钙蛋白(cardiac troponin I,cTnI)水平;KD组行常规超声心动图检测冠状动脉病变情况。结果:KD组急性期血浆BNP水平为(468.4±200.6)ng/L,高于恢复期和对照组[(91.5±12.7)ng/L、(72.3±13.5)ng/L],差异有高度统计学意义(均P<0.01)。KD组急性期患儿行超声心动图检测有冠状动脉改变者10例,其BNP水平与无冠状动脉改变者比较,差异无统计学意义(P>0.05)。KD组急性期患儿血浆BNP水平与急性期CRP、WBC及cTnI水平呈显著正相关关系(r=0.605、0.532、0.591,均P<0.05)。结论:血浆BNP水平在KD急性期显著升高,而在疾病恢复期明显降低,有助于急性期KD的诊断,但KD患儿急性期血浆BNP水平的升高与心脏、冠状动脉损害的关系还需进一步研究。

Objective： To discuss the clinical value of the change of brain natriuretic peptide （BNP） in children with Kawasaki disease （KD）. Methods： 36 cases of patients with KD were enrolled in KD group, the level of plasma BNP was detected in acute phase and recovery phase. 36 cases of patients with acute upper respiratory infection were enrolled in control group, the level of plasma BNP was detected. White blood cell count, C-reactive protein and serum cardiac tro- ponin I were measured in two groups. Echocardiogram was used to detected the pathological change of coronary artery in KD group. Results： In acute phase of KD group, the level of plasma BNP was （468.4＋200.6） ng/L, which was higher than that of recovery phase and control group [（91.5±12.7） ng/L, （72.3±13.5） ng/L], the difference was statistically significant （all P〈0.01）. 10 cases of coronary artery change were found through echocardiogram detected in acute phase of KD group, compared with patients without coronary artery change in KD group, the BNP level had no significant difference （P〉0.05）. In acute phase of KD group, BNP level correlated positively with C-reactive protein, white blood cells counts and serum cTnI （r=0.605, 0.532, 0.591, all P〈0.05）. Conclusion： In KD group, the level of plasma BNP increases in acute phase and decreases significantly in recovery phase, which is conductive to diagnose of acute phase of KD. The correlation between the plasma BNP level in acute phases of KD with the damage of heart and coronary artery still need further study.