Apelin-13在预测川崎病冠状动脉病变中的价值

Predictive value of Apelin-13 on coronary artery lesion in Kawasaki disease

目的探讨Apelin-13水平与川崎病(KD)急性期冠状动脉病变(CAL)的关系, 评估Apelin-13在预测KD患儿CAL中的价值。方法纳入2017年9月至2019年10月成都市妇女儿童中心医院收治的KD患儿240例作为KD组进行前瞻性队列研究, 其中KD并发CAL患儿(KD-CAL组)45例, KD无CAL患儿(KD-NCAL组)195例;同时选择同期住院的30例急性上呼吸道感染患儿为发热对照组, 30例健康体检儿童为健康对照组。测定所有KD患儿静脉注射丙种球蛋白前、发热对照组儿童确诊后及健康对照组儿童体检时的血常规、血清白蛋白、C反应蛋白、氨基末端脑钠肽前体(NT-proBNP)及Apelin-13水平。比较各组患儿临床资料, 采用受试者工作特征(ROC)曲线和多元Logistic回归分析确定KD并发CAL的危险因素及Apelin-13对其的预测价值。结果 KD患儿Apelin-13、血红蛋白较健康对照组、发热对照组显著降低, 差异均有统计学意义(均P<0.001), 而白细胞计数、血小板计数、C反应蛋白、NT-proBNP较健康对照组、发热对照组显著升高, 差异均有统计学意义(均P<0.001)。KD组患儿血清白蛋白水平显著低于健康对照组, 差异有统计学意义(P=0.004), 与发热对照组比较差异无统计学意义(P=0.485)。KD-CAL组较KD-NCAL组Apelin-13(t=10.102, P<0.001)、血红蛋白(t=2.034, P=0.043)显著降低, NT-proBNP、C反应蛋白显著升高(t=5.982、3.728, 均P<0.001), 差异均有统计学意义。多元Logistic回归分析显示, Apelin-13、NT-proBNP是KD并发CAL的独立预测因子, ROC分析显示, Apelin-13对CAL的最佳预测值为2.99 μg/L, 曲线下面积为0.869(95%CI:0.820~0.909), 敏感性和特异性分别为77.78%和88.67%, NT-proBNP对CAL的最佳预测值为822 ng/L, 曲线下面积为0.718(95%CI:0.656~0.774), 敏感性和特异性分别为57.78%和84.62%。结论 Apelin-13在KD并发CAL中发挥保护性作用, 是KD患儿急性期并发CAL的独立预测因子。

Objective To investigate the relationship between the level of Apelin-13 and coronary artery lesion(CAL)in patients with Kawasaki disease(KD),and assess the predictive value of Apelin-13 for CAL in acute phase of KD.Methods A total of 240 children with KD treated in Chengdu Women and Children′s Central Hospital from September 2017 to October 2019 were recruited,and were divided into KD with CAL(KD-CAL)group and KD without CAL(KD-NCAL)group.Thirty children with acute upper respiratory infection and 30 healthy children were recruited into the febrile control group and the healthy control group,respectively.Blood routine and serum levels of albumin,C-reactive protein(CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP)and Apelin-13 were mea-sured in KD children prior to intravenous gamma globulin injection and after the diagnosis of children in the febrile control group and physical examination of children in the healthy control group.The clinical data of children in each group were compared,and the risk factors of KD complicated with CAL and the predictive value of Apelin-13 were determined by using receiver operating characteristic(ROC)curve and multiple Logistic regression analysis.Results Apelin-13 and hemoglobin in children with KD were significantly decreased compared with those in the healthy control group and fever control group(all P<0.001).However,white blood cell(WBC)count,platelet count,CRP and NT-proBNP in KD group were significantly increased compared with those in the healthy control group and fever control group(all P<0.001).Serum albumin in KD children was significantly lower than that in the healthy control group(P=0.004),and there was no difference when compared with the fever control group(P=0.485).Apelin-13 and hemoglobin were significantly decreased in KD-CAL group compared with KD-NCAL group(t=10.102,P<0.001;t=2.034,P=0.043),while NT-proBNP and CRP were significantly increased(t=5.982,3.728,all P<0.001).Multiple logistic regression analysis showed that Apelin-13 and NT-proBNP were independent predictors of CAL in KD.The ROC curve analysis showed that the cut-off value of Apelin-13 for predicting CAL was 2.99μg/L,with an area under the curve(AUC)of 0.869(95%CI:0.820-0.909),sensitivity of 77.78%and specificity of 88.67%.While NT-proBNP cutoff value of 822 ng/L yielded sensitivity of 57.78%and specificity of 84.62%for predicting CAL with an AUC of 0.718(95%CI:0.656-0.774).Conclusions Apelin-13 plays a protective role in KD complicated with CAL,and could be used to predict CAL in the acute phase of KD.