血清胱抑素C对川崎病及其合并冠状动脉损害的诊断价值

The diagnostic value of serum cystatin C in Kawasaki disease and its concomitant coronary artery lesion

目的探讨血清胱抑素C(Cys-C)对川崎病(KD)及其合并冠状动脉损害(CAL)的诊断价值。方法收集2010年1月至2019年10月中国医科大学附属第一医院儿科就诊的157例急性期KD患儿(KD组)及200例健康儿童(对照组)的临床资料。根据超声心动图检查结果将KD患儿分为合并冠状动脉损害组(CAL组,123例)与未合并冠状动脉损害组(NCAL组,34例),比较2组患儿血清Cys-C、尿素氮(BUN)、肌酐(Cr)水平。同时根据Cys-C水平将KD患儿分为Cys-C高值组与Cys-C正常组,比较2组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)的差异。绘制血清Cys-C预测KD及其合并CAL的受试者工作特征(ROC)曲线,分析曲线下面积(AUC)及不同界点的临床诊断价值。结果KD组血清Cys-C值明显高于对照组(P<0.05)。Cys-C高值组与Cys-C正常组间ALT、AST水平比较未见统计学差异(均P>0.05)。CAL组血清Cys-C值明显高于NCAL组(P<0.01)。Cys-C预测KD及其合并CAL的ROC曲线的AUC分别为0.600、0.821;最佳界值分别为0.795 mg/L及0.845 mg/L。结论血清Cys-C可能对于KD具有一定的辅助诊断价值,KD急性期血清Cys-C对KD合并CAL具有预测价值。

Objective To evaluate the diagnostic value of serum cystatin C(Cys-C)in Kawasaki disease(KD)and its complication,coronary artery lesion(CAL).Methods Clinical data were collected from 157 children in the acute stage of KD(KD group)and 200 healthy children(control group)admitted to the Department of Pediatrics of the First Hospital of China Medical University from January 2010 to October 2019.According to the results of echocardiography,the children with KD were divided into two groups:a group with CAL(CAL group,123 cases)and a group without CAL(NCAL group,34 cases).The levels of serum Cys-C,urea nitrogen(BUN),and creatinine(Cr)in each group were compared.At the same time,children with KD were divided into two groups according to Cys-C level:a high Cys-C group and a normal Cys-C group,and the alanine transaminase(ALT)and aspartate aminotransferase(AST)levels were compared between the two groups.Receiver operator characteristic(ROC)curves for serum Cys-C for predicting KD and its combination with CAL were constructed,and the area under the curve(AUC)and the clinical diagnostic values of different boundary points were analyzed.Results The serum Cys-C levels in the KD group were significantly higher than those in the control group(P<0.05).There were no significant differences in ALT and AST levels between the high Cys-C group and the normal Cys-C group(P>0.05).The serum Cys-C levels in the CAL group were significantly higher than those in the NCAL group(P<0.01).The AUC of the Cys-C-predicted ROC curve of KD alone and combined with CAL were 0.600 and 0.821,respectively.The optimal cut-off points were 0.795 mg/L and 0.845 mg/L,respectively.Conclusion Serum Cys-C may have some auxiliary diagnostic value for KD,and serum Cys-C in the acute stage of KD has predictive value for KD complicated with CAL.