N端前脑钠肽与原田危险评分、小林评分对川崎病病儿冠状动脉病变风险预测价值的对比

Comparison of NT proBNP,Harada risk score and Kobayashi score in predicting coronary artery disease risk in children with Kawasaki disease

目的研究N端前脑钠肽(N terminal pro brain natriuretic peptide,NT proBNP)与原田危险评分、小林评分对川崎病病儿冠状动脉病变风险的预测价值。方法选取2017年6月至2018年12月于东莞市第三人民医院就诊的45例川崎病病儿,根据病儿是否存在冠状动脉病变,将病儿分为病变组(26例)和未病变组(19例)。入院后测定病儿血浆NT proBNP水平,并记录病儿的一般临床资料、原田危险评分、小林评分、白细胞(WBC)、血小板(PLT)和C反应蛋白(CRP)等。结果病变组年龄低于未病变组,WBC(14.45±3.75)×10^9/L、中性粒细胞(7.78±1.58)×10^9/L、PLT(391.35±51.23)×10^9/L、CRP(83.56±14.74)mg/L、NT proB NP(756.43±87.56)pg/mL、原田危险评分(5.66±1.15)分和小林评分(7.65±1.42)分均高于未病变组[(10.67±3.81,6.76±1.67,354.61±63.71,62.45±15.68,567.29±61.39,4.37±1.16,6.39±1.28)(均P<0.05)];两组病儿性别和BMI均差异无统计学意义(P>0.05)。ROC曲线显示,NT proBNP的AUC为0.941,高于原田危险评分的0.761和小林评分的0.823(Z=2.136、1.993,P=0.033、0.046);Youden指数提示NT proBNP与原田危险评分、小林评分预测川崎病病儿冠状动脉病变风险的最佳截点分别为654.44 pg/mL、5.00分和7.13分。NT proBNP预测川崎病病儿冠状动脉病变风险的灵敏度为88.46%,高于原田危险评分的65.38%及小林评分的65.38%(P<0.05)。结论NT proBNP与原田危险评分、小林评分均能对川崎病病儿冠状动脉病变风险做出预测,但NT proBNP的灵敏度更高,值得临床推广。

Objective To compare the predictive values of N terminal pro brain natriuretic peptide(NT proBNP),Harada risk score and Kobayashi score for coronary artery disease risk in children with Kawasaki disease.Methods Totally 45 cases of Kawa saki disease were selected from Dongguan Songshan Lake Central Hospital Hospital who were treated from June 2017 to December 2018 and assigned,according to the presence or absence of coronary artery disease,into lesion group(26 cases)and non lesion group(19 cases).The plasma NT proBNP level was measured after admission.The general clinical data,Harada risk score,Kobayas hi score,white blood cell(WBC),platelets(PLT)and C reactive protein(CRP)were recorded.Results The age of lesion group was significantly lower than that of non lesion group.WBC(14.45±3.75)×10^9/L,neutrophil(7.78±1.58)×10^9/L,PLT(391.35±51.23)×10^9/L,CRP(83.56±14.74)mg/L,NT proBNP(756.43±87.56)pg/mL,Harada risk score(5.66±1.15)and Kobayashi score(7.65±1.42)were significantly higher than those of non lesion group(10.67±3.81,6.76±1.67,354.61±63.71,62.45±15.68,567.29±61.39,4.37±1.16,6.39±1.28,respectively)(all P<0.05),and there were no significant differences in gender and BMI between the two groups(P>0.05).ROC curve showed that the AUC of NT proBNP was 0.941,significantly higher than that of Harada risk score 0.761 and Kobayashi score 0.823,with statistical difference(Z=2.136,1.993,P=0.033,0.046).Youden index suggested that the best cut off points for NT proBNP,Harada risk score and Kobayashi score in predicting the risk of coronary artery disease in chil dren with Kawasaki disease were 654.44 pg/mL,5.00 points and 7.13 points,respectively.The sensitivity of NT proBNP in predicting the risk of coronary artery disease in children with Kawasaki disease was 88.46%,higher than 65.38%of Harada risk score and 65.38%of Kobayashi risk score(P<0.05).Conclusion NT proBNP,Harada risk score and Kobayashi score all can predict the risk of coronary artery disease in children with Kawasaki disease,but NT proBNP is more sensitive,which is worthy of clinical promotion.