D-二聚体联合脑钠肽检测用于预测儿童川崎病急性期并发冠状动脉损害的价值

The value of D-Dimer combined with BNP detection in predicting coronary artery lesions in children with Kawasaki disease

目的探讨血浆D-二聚体(D-D)联合脑钠肽(BNP)检测在儿童川崎病急性期并发冠状动脉损害(CAL)中的预测价值。方法回顾性收集2018年7至11月南京医科大学附属儿童医院风湿免疫科收治的川崎病患儿101例作为川崎病组,根据101例川崎病患儿急性期是否并发CAL,将其分为CAL组31例和非CAL组70例。选取同期性别、年龄相匹配的健康体检儿童51例作为健康对照组。分别检测川崎病组患儿和健康对照组儿童的凝血指标、C反应蛋白(CRP)、血沉(ESR)、D-D和BNP水平。结果川崎病组患儿CRP、ESR、凝血酶原时间、纤维蛋白原、纤维蛋白/纤维蛋白原降解产物(FDP)、D-D和BNP水平均高于健康对照组,活化部分凝血酶原时间水平低于健康对照组,差异均有统计学意义(均P<0.05);CAL组患儿CRP、ESR、FDP、D-D和BNP水平均高于非CAL组,差异均有统计学意义(均P<0.05)。经Pearson积差相关分析,CAL组患儿血浆D-D与BNP水平呈正相关(r=0.744,P<0.01)。D-D的AUC为0.852,最佳临界值为0.75ng/L,灵敏度为0.90,特异度为0.66;BNP的AUC为0.862,最佳临界值为111.50ng/L,灵敏度为0.87,特异度为0.76;D-D联合BNP的AUC为0.877,灵敏度为0.97,特异度为0.61。结论川崎病患儿急性期血浆中D-D及BNP水平增高,可作为预测川崎病急性期并发CAL的重要指标。

Objective To explore the predictive value of plasma D-Dimer(D-D)and BNP level in coronary artery lesions(CAL)in children with Kawasaki disease.Methods Clinical data of 101 children with Kawasaki disease admitted from July to November 2018 were retrospectively analyzed,including 31 cases with CAL(CAL group)and 70 cases without CAL(non-CAL group);51 healthy children served as healthy control group.Coagulation parameters,CRP,ESR,D-D and BNP levels were measured in all subject.Results CRP,ESR,PT,Fbg,FDP,D-D and BNP levels were significantly increased in Kawasaki disease group than in the healthy control group(all P<0.05).CRP,ESR,FDP,D-D and BNP levels in the CAL group were significantly higher than those in the non-CAL group(all P<0.05).Plasma D-D was positively correlated with BNP level in the CAL group(r=0.744,P<0.01).ROC analysis showed that the area under the curve(AUC)of plasma D-D level in predicting CAL was 0.852,taking D-D 0.75ng/L as the cut-off value,the sensitivity and specificity was 0.90 and 0.66;AUC of plasma BNP level was 0.862,taking BNP 111.50ng/L as the cut-off value,the sensitivity and specificity was 0.87 and 0.76;AUC of plasma D-D combined with BNP level was 0.877,the sensitivity and specificity was 0.97 and 0.61.Conclusion The plasma levels of D-D and BNP are increased in children with Kawasaki disease and can be used as an early indicator of predicting CAL.