氨基末端脑钠肽前体水平对丙种球蛋白无反应性川崎病的预测价值

Predictive value of plasma brain natriuretic peptide in IVIG-resistant Kawasaki disease

目的:探讨氨基末端脑钠肽前体(NT-pro BNP)对静脉输注丙种球蛋白(IVIG)无反应性川崎病(KD)的预测价值。方法:回顾分析临床资料完整的KD患儿102例。根据患儿对IVIG治疗的敏感性,分为IVIG敏感组及IVIG无反应组。对患儿的临床特征及实验室检查等资料进行比较,并行ROC曲线分析。结果:102例KD患儿中,有88例(86.2%)对丙种球蛋白敏感,14例(13.7%)无反应。IVIG敏感组血浆NT-pro BNP水平为(830.91±748.08)ng/L,无反应组为(1 820.67±1 454.13)ng/L,无反应组血浆NT-pro BNP水平明显高于敏感组(P为0.010),差异有统计学意义。IVIG无反应组患儿WBC、CRP水平显著高于IVIG敏感组(P分别为0.019,<0.001),而前者血清钠(Na+)、肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平明显低于后者(P分别为0.001,0.021,0.030),差异有统计学意义。线性相关性分析显示,KD患儿血浆NT-pro BNP浓度与CRP存在明显正相关(r=0.37,P=0.02),与Na+成负相关(r=-0.33,P=0.01)。血浆NT-pro BNP浓度与WBC、血小板、血沉间未见相关性。当血浆NT-pro BNP浓度为746.3 ng/L时,预测KD患儿对丙种球蛋白是否敏感的灵敏度为0.917,特异度为0.674。结论:血浆NT-pro BNP水平升高可作为预测KD患儿对丙种球蛋白是否敏感特异性指标,特别是当血浆NT-pro BNP浓度高于746.3 ng/L时,KD患儿发生丙种球蛋白无反应的可能性大。

Objective： To discuss the predictive value of plasma brain natriuretic peptide （BNP）in IVIG-resistant Kawasaki disease （KD）. Methods： Medical records of 102 children diagnosed with KD were reviewed .Sub-jects were then divided into two groups： IVIG-responsive and IVIG-resistant. The clinical features and laboratory data were obtained and analyzed by ROC. Results： Of 102 patients ,14（13.7%） children with KD were not responsive to initial intravenous immu-noglobulin （IVIG） treatment. For the two groups of KD patients, the levels of plasma BNP,WBC and CRP in IVIG-resistant group were higher than the IVIG-responsive group. There were a significant positive linear correlation between BNP and CRP （r=0.37,P=0.02）and a negative linear correlation between BNP and Na＋ （r=-0.33,P=0.01）. When the level of plasma BNP was 746.3 ng/L, the predictive sensitivity in patients with KD was 0.917, and the specificity was 0.674. Conclusion： The increase of plasma BNP level can be used to predict whether children with KD are responsive to initial intravenous immu-noglobulin （IVIG） treatment, especially when the level of plasma BNP is higher than 746.3 ng /L.