血清白介素-17A、白介素-18、白介素-9、肾上腺髓质素前体N端20肽和N末端脑钠肽前体水平对急性期川崎病患儿并发冠状动脉病变的预测价值

The predictive value of serum levels of interleukin-17A,interleukin-18,interleukin-9,proadrenomedullin N-terminal 20 peptide and N-terminal pro-brain natriuretic peptide in acute Kawasaki's disease children complicated with coronary artery lesions

目的探讨血清白介素-17A(interleukin-17A,IL-17A)、白介素-8(interleukin-8,IL-8)、白介素-9(interleukin-9,IL-9)、肾上腺髓质素前体N端20肽(proadrenomedullin N-terminal 20 peptide,PAMP)、N末端脑钠肽前体(N-terminal pro-brain natri-uretic peptide,NT-proBNP)水平对急性期川崎病患儿并发冠状动脉病变(coronary arterial lesions,CAL)的预测价值。方法选取2016年1月至2018年5月成都市妇女儿童中心医院收治的69例急性期川崎病患儿纳入急性组,并随机选取同期于该院随访的50例恢复期川崎病患儿纳入恢复组,50例健康体检儿童纳入对照组。比较三组儿童血清IL-17A、IL-18、IL-9、PAMP和NT-proBNP水平,根据超声心动图检查结果将急性组患儿分为CAL组(16例)和无CAL组(53例),比较CAL组和无CAL组患儿以上各血清指标水平,采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)评价上述各血清指标对CAL的预测价值。结果急性组患儿血清IL-17A、IL-18、IL-9、PAMP和NT-proBNP水平均显著高于恢复组和对照组(均P<0.05),恢复组患儿血清IL-17A、IL-18、IL-9、PAMP和NT-proBNP水平均显著高于对照组(均P<0.05)。CAL组患儿血清IL-17A、IL-18、PAMP和NT-proBNP水平均显著高于无CAL组(均P<0.05),但两组患儿血清IL-9水平比较差异无统计学意义(P>0.05)。血清IL-17A、IL-18、PAMP和NT-proBNP水平对急性期川崎病患儿并发CAL具有中等预测价值,其AUC分别为0.833、0.786、0.755和0.801,其中IL-17A的预测价值最高,Youden指数为0.667。结论急性期川崎病患儿血清IL-17A、IL-18、IL-9、PAMP和NT-proBNP水平均显著升高,且与病情变化有关,血清IL-17A、IL-18、PAMP和NT-proBNP水平能预测急性期川崎病患儿CAL的发生,具有潜在的预后评估价值。

Objective To explore of predictive value of serum levels of interleukin-17A(IL-17A),interleukin-8(IL-8),interleukin-9(IL-9),proadrenomedullin N-terminal 20 peptide(PAMP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in acute Kawasaki's disease children complicated with coronary arterial lesions(CAL).Method 69 children with acute Kawasaki's disease admitted to Chengdu Women's&Children's Central Hospital from January 2016 to May 2018 were enrolled the study as acute group.During the same period in that hospital,50 children with recovery Kawasaki's disease were enrolled as recovery group,and 50 healthy children were selected as control group.Serum levels of IL-17A,IL-18,IL-9,PAMP and NT-proBNP were compared among the three groups.Children in acute group were divided into CAL group and non-CAL group according to result of echocardiography.Serum levels of all indicators were compared between CAL group and non-CAL group.The area under the curve(AUC)of receiver operator characteristic curve(ROC)was performed to investigate the predictive value of all indicators for CAL.Result The levels of serum IL-17A,IL-18,IL-9,PAMP and NT-proBNP in acute group were significantly higher than those in recovery group and control group(all P<0.05),and the levels of serum IL-17A,IL-18,IL-9,PAMP and NT-proBNP in recovery group were significantly higher than those in control group(all P<0.05).The levels of serum IL-17A,IL-18,PAMP and NT-proBNP in CAL group were significantly higher than those in non-CAL group(all P<0.05),but there was no significant difference in the levels of IL-9 between the two groups(P>0.05).The levels of serum IL-17A,IL-18,PAMP and NT-proBNP had moderate predictive value for CAL,AUC were 0.833,0.786,0.755 and 0.801 respectively.IL-17A had the highest predictive value,Youden index was 0.667.Conclusion The levels of serum IL-17A,IL-18,IL-9,PAMP and NT-proBNP in children with acute Kawasaki's disease are significantly increased,which are related to change of disease condition.And the levels of serum IL-17A,IL-18,PAMP and NT-proBNP can predict the occurrence of CAL and have potential value of prognosis evaluation.