血清铁蛋白鉴别急性期皮肤黏膜淋巴结综合征与常见小儿急性发热性疾病

Role of serum ferritin in distinguishing acute cutaneous mucosal lymph node syndrome from common acute febrile diseases in children

目的运用血清铁蛋白(SF)鉴别急性期皮肤黏膜淋巴结综合征与小儿常见急性发热性疾病。方法选取2016年至2021年在苏州大学附属常州市肿瘤医院及南京医科大学附属常州第二人民医院就诊的皮肤黏膜淋巴结综合征患者185例,其中男性100例,女性85例;年龄1(1,2)岁。并同时选取其他小儿常见急性发热性疾病患者194例,其中男性99例,女性95例;年龄2(1,3)岁。疾病主要包含支气管肺炎,上呼吸道感染,幼儿急诊,疱疹性咽峡炎及化脓性扁桃体炎等。实验室检查测量白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)、嗜酸性粒细胞计数(EO)、血红蛋白量(Hb)、血小板计数(PLT)、超敏C反应蛋白(超敏CRP)、C反应蛋白(CRP)、血沉(ESR)、总胆红素、总蛋白、白蛋白、谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB),降钙素原(PCT)、D-二聚体、N端脑钠肽前体(NT-proBNP)、SF、T细胞亚群(CD19、CD3、CD4、CD8)和NK细胞等血液学指标。结果急性期皮肤黏膜淋巴结综合征患者WBC、NEUT、EO、PLT、超敏CRP、CRP、ESR、总胆红素、ALT、LDH、CK-MB,PCT、D-二聚体、NT-proBNP、SF、T细胞亚群(CD19、CD4、CD8)、CD4/CD8和NK细胞所测值显著高于其他小儿急性发热性疾病(P<0.01),而Hb、总蛋白、白蛋白、AST、CK和CD3所测值显著低于其他小儿急性发热性疾病(P<0.01)。ROC曲线显示SF截点值为104.7 ng/mL时可以有效鉴别急性期皮肤黏膜淋巴结综合征与其他小儿急性发热性疾病,其诊断敏感度和特异度分别为92%和52.94%。结论急性期皮肤黏膜淋巴结综合征患者SF较小儿急性发热性疾病明显升高;SF截点值为104.7 ng/mL时可以有效鉴别急性期皮肤黏膜淋巴结综合征与小儿急性发热性疾病。

Objective To distinguish acute cutaneous mucosal lymph node syndrome from common acute febrile diseases in children by using serum ferritin.Methods We retrospectively collected the subjects from Changzhou Tumor Hospital Affiliated to Soochow University(Changzhou Fourth People’s Hospital),and the Affiliated Changzhou No.2 People’s Hospital to Nanjing Medical University from 2016 to 2021.There were 185 patients with acute cutaneous mucosal lymph node syndrome,including 100 males and 85 females,aged 1(1,2)years.194 patients with other acute febrile diseases in children were enrolled for the study,with 99 males and 95 females,aged 2(1,3)years,mainly including bronchopneumonia,upper respiratory tract infection,infant emergency,vesicular angina and suppurative tonsillitis.The white blood cell count and neutrophil count,lymphocyte count,monocyte count,eosinophil count,hemoglobin volume,platelet count,high-sensitivity C-reactive protein,C-reactive protein,erythrocyte sedimentation rate,total bilirubin,total protein,albumin,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,creatine kinase,creatine kinase isozyme,procalcitonin,D-dimer,brain natriuretic peptide,serum ferritin,T cell subsets(CD19,CD3,CD4,CD8)and NK cells were measured and recorded.Results The values of white blood cell count,neutrophil count,eosinophil count,platelet count,high-sensitivity C-reactive protein,C-reactive protein,erythrocyte sedimentation rate,total bilirubin,alanine aminotransferase,lactate dehydrogenase,creatine kinase isozyme,procalcitonin,D-dimer,N-terminal pro-B-type natriuretic peptide,serum ferritin,T cell subsets(CD19,CD4,CD8),CD4/CD8 and NK cells were significantly higher than those of other acute febrile diseases in children(P<0.01),while the values of hemoglobin,total protein,albumin,aspartate aminotransferase,creatine kinase and CD3 were significantly lower than those of other acute febrile diseases in children(P<0.01).The serum ferritin cut-off value of 104.7 ng/L effectively distinguished patients with KD from those with other acute febrile illnesses,with a sensitivity and specificity of 92%and 52.94%,respectively.Conclusion The serum ferritin of patients with acute cutaneous mucosal lymph node syndrome is significantly higher than that of other acute febrile diseases in children.The serum ferritin cut-off value of 104.7 ng/L can effectively distinguish patients with KD from those with other acute febrile illnesses.