PTX3及NT-proBNP在小儿川崎病冠脉损害中的意义

Significance of PTX3 and NT-proBNP in coronary artery lesion in children with Kawasaki disease

目的探讨PTX3及NT-proBNP作为生物标记物在评估儿童川崎病(KD)冠脉损害中的意义。方法检测64例KD患儿急性期及恢复期血清中PTX 3、NT-proBNP和炎症因子(IL-1β、IL-6、TNF-α)浓度,并在急性期行心脏彩超检查;同时选取同年龄仅呼吸道感染患儿和健康体检儿童各30例作为对照组进行比较和相关性评价;应用受试者工作特征曲线(ROC)分析急性期PTX3和NT-proBNP对KD的诊断效能。结果各组间血清中IL-1β、IL-6、TNF-α、NT-proBNP和PTX 3浓度的差异均有统计学意义(P<0. 01);各指标均以KD组急性期为最高。KD急性期冠状动脉损伤(CAL)组与NCAL组间比较,血清PTX3的差异有统计学意义(P<0.05)。PTX3和NT-proBNP均与IL-1β、IL-6、TNF-α成正相关(r=0.645～0.697,P<0.001)。PTX3和NT-proBNP诊断KD的ROC曲线下面积(AUC)分别为0.909(95%CI:0.862～0.957,P<0. 001)和0. 918(95%CI:0. 856～0. 981,P<0. 001)。结论 PTX 3和NT-proBNP有助于KD诊断,PTX 3与病情活动性相关,可用作病情监测。

Objective To explore the significance of PTX3 and NT-proBNP as biomarkers in evaluating the coronary artery lesion of Kawasaki disease(KD).Methods Concentrations of serum PTX3,NT-proBNP and inflammatory cytokines(IL-1β,IL-6,TNF-α)in 64 children with KD on acute and convalescent phases were detected,and color Doppler ultrasound examination was performed on the acute phase.At the same time,30 children with only respiratory tract infection and 30 healthy children of same age were selected as control groups.Comparison and correlation evaluation were carried out for these data.Receiver operating characteristic curve was used to analyze the diagnostic efficiency of PTX3 and NT-proBNP on the acute phase for KD.Results Levels of serum PTX3,NT-proBNP and inflammatory cytokines(IL-1β,IL-6,TNF-α)on the acute phase in children with KD were higher than that on convalescent phase,and no statistical difference in two control groups was observed.PTX3 on convalescent phase was still higher than that in control groups,while there was no significant difference for other factors.The difference of serum PTX 3 between CAL and NCAL group of children with KD on the acute phase was statistically significant,meanwhile no significant difference for NT-proBNP on the two phases was found.Serum levels of PTX3 and NT-proBNP of all samples were positively correlated with that of IL-1β,IL-6 and TNF-α(γ=0.666,0.697,0.645 and 0.674,0.675,0.694,P=0.000).Area under the receiver operating curve of PTX3 and NT-proBNP were 0.909(95%CI:0.862-0.957,P=0.000)and 0.918(95%CI:0.856-0.981,P=0.000),respectively.Conclusions PTX3 and NT-proBNP reflect qualitative feature and location of coronary vasculitis in KD separately.Joint combination of the both is helpful to KD early diagnosis.PTX 3 is related to the status of the the disease activity as well,thus can be used for monitoring the progress of KD.