N端脑钠肽前体及白细胞介素-6在预测川崎病并冠状动脉损害中的临床价值

Clinical value of N-terminal brain natriuretic peptide precursors and interleukin-6 in predicting Kawasaki disease with coronary artery damage

目的探讨血清白细胞介素-6(IL-6)和N端脑钠肽前体(NT-proBNP)在预测川崎病并冠状动脉损害(CAL)中的临床价值。方法选择2019年11月至2021年11月60例在蚌埠市第一人民医院收治并确诊为川崎病的患儿作为研究对象,根据超声心动图诊断结果分为CAL组24例和无CAL组(nCAL组)36例,同期收治30例呼吸道感染患儿作为对照组。采用两步双抗夹心酶联免疫吸附法(ELISA)检测患儿血清IL-6、NT-proBNP、C反应蛋白(CRP)、白细胞(WBC)、红细胞沉降率(ESR)、降钙素原(PCT)、白蛋白及血钠的水平,采用多因素Logistic回归分析川崎病并CAL的独立危险因素,并采用ROC曲线分析IL-6和NT-proBNP水平对川崎病并CAL的诊断效能。结果川崎病患儿血清NT-proBNP、IL-6、CRP、WBC、ESR及PCT水平显著高于对照组,而白蛋白及血钠水平显著低于对照组(P<0.05,P<0.01)。CAL组患儿血清NT-proBNP、IL-6、CRP、WBC、ESR均显著高于nCAL组,白蛋白及血钠水平显著低于nCAL组(P<0.05,P<0.01)。多因素Logistic回归分析显示,IL-6和NT-proBNP为川崎病并CAL发生的独立影响因素(P<0.05)。IL-6、NT-proBNP的ROC曲线下面积分别为0.683、0.886;其诊断临界值分别为185.39 pg/ml和1020.45 pg/ml;诊断敏感性分别为85.70%和90.50%,特异性分别为77.83%和88.91%。结论血清IL-6和NT-proBNP水平的升高可作为早期预测川崎病并CAL的特异性生化指标,且NT-proBNP预测CAL发生的准确率更高。

Objective To investigate the clinical value of serum interleukin 6(IL-6)and N-terminal brain natriuretic peptide precursor(NT-proBNP)in predicting Kawasaki disease(KD)with coronary artery damage(CAL)in children with KD.Methods Sixty children diagnosed with KD at the Bengbu First People s Hospital from November 2019 to November 2021 were selected as study subjects.According to the results of echocardiography,they were divided into CAL group(n=24)and non-CAL group(nCAL group,n=36),and 30 children with respiratory tract infection admitted at the same time were selected as control group.Serum levels of IL-6,NT-proBNP,C-reactive protein(CRP),white blood cells(WBC),erythrocyte sedimentation rate(ESR),calcitoninogen(PCT),albumin and sodium were measured by two-step double antibody sandwich enzyme-linked immunosorbent assay(ELISA).Multivariate Logistic regression was used to analyze the independent risk factors of KD and CAL,and ROC curve was used to analyze the diagnostic efficacy of IL-6 and NT-proBNP levels in KD and CAL.Results Compared with control group,serum NT-proBNP,IL-6,CRP,WBC,ESR and PCT levels were significantly higher,while albumin and blood sodium levels were significantly lower in children with KD(P<0.05,P<0.01).Compared with nCAL group,serum NT-proBNP,IL-6,CRP,WBC,ESR were significantly higher,while albumin and blood sodium levels were significantly lower in the CAL group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that IL-6 and NT-proBNP were independent influencing factors of KD and CAL(P<0.05).The areas under the ROC curves of IL-6 and NT-proBNP were 0.683 and 0.886,respectively,their diagnostic critical values were 185.39 pg/ml and 1020.45 pg/ml,respectively,the diagnostic sensitivity was 85.70%and 90.50%,and the specificity was 77.83%and 88.91%.Conclusion Elevated serum IL-6 and NT-proBNP levels can be used as specific biochemical indicators for early prediction of KD and CAL,and NT-proBNP is more accurate in predicting the occurrence of CAL.