羧化不全骨钙素在川崎病并冠状动脉损害诊断中的意义

Significance of undercarboxylated osteocalcin in the diagnosis of Kawasaki disease with coronary artery lesions

目的探讨川崎病（KD）患儿，尤其是有冠状动脉损害（CALs）患儿血浆羧化不全骨钙素水平的变化及羧化不全骨钙素在KD并CALs诊断中的意义。方法收集2015年1至12月在山西省儿童医院心血管与风湿免疫科住院治疗的36例KD患儿资料，其中男20例，女16例；年龄（2.3±1.1）岁。根据患儿病程的不同，分为急性期和亚急性期。根据超声心动图的结果，将KD患儿分为CALs组和无冠状动脉损害（NCALs）组。本院同期体检的健康儿童25例为健康对照组，其中男13例，女12例；年龄（2.6±1.0）岁。采用双抗体夹心酶联免疫吸附法测定血浆羧化不全骨钙素水平。采用Sigmaplot 12.5软件进行统计学处理，采用受试者工作特征（ROC）曲线评价血浆羧化不全骨钙素在KD及CALs诊断中的效应。结果健康对照组、急性期和亚急性期KD患儿的血浆羧化不全骨钙素水平分别为（16.4±1.6） μg/L、（14.2±1.6） μg/L、（14.3±1.7） μg/L，与健康对照组相比，急性期和亚急性期KD患儿的羧化不全骨钙素水平均明显降低，差异均有统计学意义（q＝6.088、5.687，均P〈0.01）；急性期与亚急性期相比，羧化不全骨钙素水平差异无统计学意义（q＝0.466，P〉0.05）。急性期有CALs患儿、NCALs患儿的血浆羧化不全骨钙素水平分别为（12.9±1.2） μg/L、（15.0±1.4） μg/L，与健康对照组相比血浆羧化不全骨钙素水平均明显降低，差异均有统计学意义（q＝8.711、3.891，均P〈0.01）；与NCALs患儿相比，急性期有CALs患儿的血浆羧化不全骨钙素水平明显降低，差异有统计学意义（q＝5.171，P〈0.01）。有CALs的患儿亚急性期血浆羧化不全骨钙素的水平为（13.0±1.3） μg/L，与急性期相比差异无统计学意义（t＝0.257，P〉0.05）。血浆羧化不全骨钙素水平为15.7 μg/L时诊断KD的敏感性为79%，特异性为82%，阳性预测率为88%，阴性预测率为70%。血浆羧化不全骨钙素水平为13.7 μg/L时诊断KD并CALs的敏感性为83%，特异性为88%，阳性预测率为83%，阴性预测率为88%。结论羧化不全骨钙素与KD的发生、发展有关，血浆羧化不全骨钙素有助于KD并CALs的诊断。

Objective To investigate the changes and diagnostic significance in plasma undercarboxylated osteocalcin in children with Kawasaki disease （KD）, especially with coronary artery lesions （CALs）.Methods The data of 36 KD children were collected, who were inpatients at Department of Cardiovascular and Rheumatology, Shanxi Province Children′s Hospital from January 2015 to December 2015, including 20 boys and 16 girls, aged （2.3±1.1） years old.According to the course of the disease, KD children were divided into an acute stage group and a subacute stage group.Based on the echocardiography findings, KD children were subdivided into CALs group and no coronary artery lesions （NCALs） group.Twenty-five healthy children from the physical examination during the same period were selected as the healthy control group, 13 boys and 12 girls, aged （2.6±1.0） years old.Plasma undercarboxylated osteocalcin level was measured by double antibody sandwich enzyme-linked immunosorbent method.Sigmaplot 12.5 software was used to analyze the data statistically, and the receiver-operating characteristic （ROC） curve was used to evaluate the diagnostic effect of plasma undercarboxylated osteocalcin in KD with CALs.Results The levels of plasma undercarboxylated osteocalcin in the healthy control group, the acute stage group and the subacute stage group were （16.4±1.6） μg/L, （14.2±1.6） μg/L, （14.3±1.7） μg/L, respectively.Compared with the healthy control group, the plasma undercarboxylated osteocalcin level in the acute stage and the subacute stage were significantly lower, the differences were statistically significant （q=6.088, 5.687, all P〈0.01）. But there was no difference of plasma undercarboxylated osteocalcin level between the acute stage group and the subacute stage group （q=0.466, P〉0.05）. The levels of plasma undercarboxylated osteocalcin in acute stage group with CALs and acute stage group with NCALs were （12.9±1.2） μg/L, （15.0±1.4） μg/L.Compared with healthy control group, the plasma undercarboxylated osteocalcin levels of children with CALs and with NCALs were obviously decreased, the differences were statistically significant （q=8.711, 3.891, all P〈0.01）. There was a statistical difference in plasma undercarboxylated osteocalcin level between the acute stage with CALs and the acute stage with NCALs （q=5.171, P〈0.01）. The plasma undercarboxylated osteocalcin levels of KD children with CALs in the subacute stage was （13.0±1.3） μg/L.Compared with acute stage, there was no statistical difference （t=0.257, P〉0.05）. There was a sensitivity of 79%, specificity of 82%, positive predictive value of 88% and negative predictive value of 70% for the 15.7 μg/L undercarboxylated osteocalcin for diagnosing KD.There was a sensitivity of 83%, specificity of 88%, positive predictive value of 83% and negative predictive value of 88% for the 13.7 μg/L undercarboxylated osteocalcin for diagnosing KD with CALs.Conclusions Osteocalcin is related to the pathogenesis and development of KD.Plasma undercarboxylated osteocalcin contributes to the diagnosis of KD with CALs.