血清Meprin A联合NT-proBNP对川崎病伴冠状动脉损害预测价值的研究

Value of serum Meprin A and NT-proBNP in predicting coronary artery lesions with Kawasaki disease

为了探讨血清Meprin A联合NT-proBNP对川崎病(KD)伴冠状动脉损害(CAL)的预测价值,选取宁波市妇女儿童医院住院KD患儿334例为实验组,同期匹配的上呼吸道感染患儿201例为对照组,实验组依据超生心动图结果分为冠状动脉损害组(CAL组n=64例)与无冠状动脉损害组(NCAL组n=270例),所有KD患儿在急性期与恢复期分别检测血清Meprin A、NT-proBNP等相关实验室指标,运用Logistic回归方程拟合Meprin A及NT-proBNP的联合诊断模型,并绘制受试者工作特征(ROC)曲线,用DeLong检验两组之间曲线下面积.结果发现:KD患儿急性期血清Meprin A、NT-proBNP水平均显著高于缓解期及对照组,差异有统计学意义(P<0.001);CAL组患儿血清Meprin A、NT-proBNP水平均高于NCAL组(P<0.001);Spearman相关性分析显示KD患儿急性期血清Meprin A与NT-proBNP、CRP、ESR之间呈正相关性;ROC曲线分析当血清Meprin A>7.7ng·mL^(-1)时,预测KD患儿伴CAL的灵敏度为84.37%,特异度为67.04%,曲线下面积为0.809;NT-proBNP>966ng·L^(-1)预测KD患儿伴CAL的灵敏度为84.37%,特异度为79.63%,曲线下面积为0.883;联合检测诊断KD伴CAL的预测值>0.134,灵敏度及特异度分别为75.00%、92.22%,曲线下面积为0.874.DeLong检验表明二者联合检测及血清NT-proBNP诊断KD伴CAL的ROC曲线下面积均大于血清Meprin A,差异有统计学意义,而联合检测特异度为92.22%.因此,Meprin A、NT-proBNP可能参与KD的致病过程,且与KD伴冠状动脉损害密切相关,可用于KD伴冠状动脉损害的辅助诊断.二者联合检测的诊断特异度均高于单一检测,可为其早期诊断提供可靠证据.

The current study was aimed at investigating whether serum Meprin A and NT-proBNP level enabled to predict the coronary artery lesions with Kawasaki disease(KD).A total of 334 KD children and 201 upper children with respiratory infection participated the study.KD group was classified into CAL subgroup(n=64)and NCAL subgroup(n=270),based on the presence of coronary artery lesions.Serum Meprin A,NT-proBNP and other parameters were analyzed.Additionally,Logistic regression equation was used to fit the joint diagnosis model of Meprin A and NT-proBNP.The receiver operating characteristic(ROC)curve was drawn.Delong was used to test the area under the curve between the two groups.The results showed that serum Meprin A and NT-proBNP level were significantly higher in acute KD,compared with convalescence KD and the control group(P<0.001,P<0.001 respectively).Compared with NCAL subgroup,serum Meprin A,NT-proBNP level were also increased in CAL subgroup(P<0.001).Spearman correlation analysis showed that there was a positive correlation between serum Meprin A and NT-proBNP,CRP,ESR in children with acute KD.ROC curve analysis showed serum Meprin A level>7.7ng·mL^(-1) with the 84.37%sensitivity and the 67.04%specificity for predicting CAL the AUC area was 0.809,NT-proBNP>966ng·L^(-1) predicts the sensitivity of KD children with CAL was 84.37%,the specificity was 79.63%,the AUC area was 0.883.The predictive value of combined detection and diagnosis of KD with CAL was>0.134.The sensitivity and specificity were 75.00%and 92.22%,respectively.The AUC area was 0.874.DeLong test showed that the area under the ROC curve of NT-proBNP and the combined detection and diagnosis of KD with CAL were larger than that of serum Meprin A.The area under the ROC curve of NT-proBNP was larger than that of the joint detection,but there was no significant difference in the diagnostic efficacy of the two groups.The results indicate that Meprin A and NT-proBNP may be involved in the pathogenesis of KD,and are closely related to KD with coronary artery lesions.KD with CAL can be used as an auxiliary diagnosis.Moreover,the diagnostic specificity of the combined test is higher than that of the single test,showing that combined test could provide reliable evidence for its early diagnosis.