川崎病患儿血清PCT变化及其与冠状动脉损害的关系研究

A Study of PCT and Its Association with Coronary Artery Disease in Children with Kawasaki Disease

目的研究川崎病(KD)患儿血清降钙素原(PCT)值及其与冠状动脉损害的关系。方法回顾分析了近2年在笔者医院住院的155例川崎病患儿血清PCT浓度、白细胞(WBC)总数、C反应蛋白(CRP)和血沉(ESR)测定值,并与笔者医院正常参考值比较,以高于正常标准为异常。根据超声心动图检查结果,将全部患儿分为冠状动脉(CA)损害组和无CA损害组,分析两组间血清PCT值、WBC总数、CRP和ESR差异性。结果川崎病急性期血液中WBC总数、CRP、ESR等炎性指标明显异常,PCT在半数川崎病患儿中增高,半数正常。本组CA损害者约占23.8%(37/155),其中3例患儿呈瘤样扩张。CA损害组与无CA损害组间异常PCT阳性率无显著性差异,但CA损害组异常PCT浓度值明显高于无CA损害组。结论 PCT作为一个次级炎性指标,其敏感度低于WBC总数、CRP、ESR等传统的炎性指标,故PCT不是诊断川崎病的主要有效指标。PCT异常也不能预测CA损害发生,但临床医生应重视川崎病患儿血浆异常增高的PCT值。

Objective To study the serum level of procalcitonin（PCT） in children with Kawasaki disease（KD） and its association with coronary artery disease. Methods The serum level of PCT,total white blood cells（WBC） ,C reactive protein（CRP） and erythrocyte sedimentation rate （ESR） in 155 children with KD were analyzed retrospectively. All the determined PCT,WBC, CRP and ESR were defined abnormality if they were beyond the normal. All the children were divided into two groups： one group with normal coronary artery, and one group with dilated coronary artery, based on the echocardiography. The PCT level,WBC,CRP and ESR were compared significantly between two groups. Results WBC,CRP and ESR in each children with KD increased significantly in the early days of the course. However, the significant increased PCT level was found in only half children, normal PCT level in another half children. About 23% children had dilated coronary artery. There were no significant difference among the abnormal rates of PCT between normal coronary artery group and dilated coronary artery group. But the group with dilated coronary artery had higher PCT level than the group with normal coronary artery. Conclusion Being a secondary inflammatory factor, PCT is less sensitive than WBC,CRP and ESR in the diagnosis of KD. The dilated coronary artery cannot be predicted only based on the abnormal PCT. But more attention should be paid on the higher PCT level in children with KD.