血清8-羟基脱氧鸟苷在川崎病患儿合并冠脉损害中的变化及意义

Changes and Significance of Serum 8-hydroxy-2'-deoxyguanosine in Kawasaki Disease Children with Coronary Artery Lesions

目的探讨血清8-羟基脱氧鸟苷(8-Hydroxy-2'-deoxyguanine,8-OHDG)与川崎病(Kawasaki disease,KD)的相关性,判断其在冠脉损害中的预测价值。方法应用酶联免疫吸附法(ELISA)分别检测30例川崎病(KD)患儿急性期(其中冠脉扩张者10例,冠脉正常者20例)、恢复期及12例正常对照组儿童和12例发热组儿童血清8-OHDG水平,并进行相互比较。将KD患儿分为有冠脉损伤(CAL)组与无冠脉损伤(NCAL)组,检测两组血清8-OHDG和脑钠肽水平,最后运用ROC曲线比较8-OHDG和脑钠肽在川崎病冠脉损害中的预测价值。结果 KD急性期血清8-OHDG水平较恢复期、正常对照组、发热组比较明显升高,差异有统计学意义(P<0.05)。KD急性期合并CAL组患儿8-OHDG较NCAL组明显升高,差异有统计学意义(P<0.05)。KD急性期合并CAL组患儿脑钠肽亦较NCAL组明显升高,差异有统计学意义(P<0.01)。ROC曲线分析显示,血清8-OHDG的AUC为0.820,诊断界值为57.02pg/ml,阳性预测值64.3%,阴性预测值93.8%。脑钠肽AUC为0.745,诊断界值为815pg/ml,敏感度为100%,特异性为45%,阳性预测值47.6%,阴性预测值100%。结论血清8-OHDG对KD患儿合并冠脉损害的预测价值大于脑钠肽,可作为早期预测川崎病冠脉损害的标志物。

Objective To investigate the changes of serum 8 - hydroxy - 2＇ - deoxyguanosine （8 - OHDG） in Kawasaki disease （KD） children and to explore the importance of 8 - OHDG in predicting the severity of coronary artery lesions in Kawasaki Disease. Methods The serum 8 - OHDG was measured in KD patients group （ n = 60）, fever patients group （ n = 12） and health control group （n = 12） by ELISA method. Among the KD patients, 30 KD patients were in acute stage （10 cases had coronary artery lesions, 20 coronary were normal） and 30 patients were in recovery stage. The serum 8 - OHDG and brain natriuretic peptide （BNP） were also compared between patients with coronary artery lesions （CALs） and patients with no coronary artery lesions （ NCALs）. ROC curve analysis was used to test the 8 - OHDG and BNP predictive values in KD with coronary artery lesions. Results The serum level of 8 - OHDG was higher in acute KD patients than recovery KD patients ,fever patients and healthy children （P 〈 0.05 ）. The serum 8 - OHDG was higer in CALs patients than the NCALs patients （P 〈 O. 05 ）. The serum BNP was higer in CALs patients than the NCALs patients （ P 〈 0.01 ）. A- nalysis of the ROC curve showed that serum 8 - OHDG had a positive predictive value of 64.3% and a negative predictive value of 93.8% for distinguishing KD with CALs from KD NCALs when cutoff value was 57.02pg/ml. The area under the curve was 0. 820. The serum BNP had a a positive predictive value of 47.6% and a negative predictive value of 100% for distinguishing KD with CALs from KD NCALs when cutoff value was 815pg/ml. The area under the curve was 0. 745. Conclusion The serum 8 - OHDG may have better pre- dictive value than BNP in diagnose KD children with coronary artery lesions.