0~6月龄婴儿川崎病血清BNP、PCT、IL-6的变化及临床意义

Changes and clinical significance of serum BNP,PCT,and IL-6 in infants with Kawasaki disease aged 0-6 months

目的研究0~6月龄婴儿川崎病(Kawasaki disease,KD)血清中N末端B型脑钠肽原(NT-proBNP)、降钙素原(PCT)、白细胞介素-6(IL-6)表达水平及临床意义。方法收集2018年1月1日至2020年12月31日郑州大学附属儿童医院收治KD患儿72例,根据临床表现及体征分为典型组(32例)和不典型组(40例),并选取同期因发热住院治疗非KD患儿为对照组(30例)。典型组患儿男20例,女12例,月龄(2.7±0.2)个月;不典型组患儿男23例,女17例,月龄(2.9±0.1)个月;对照组患儿男17例,女13例,月龄(2.9±0.3)个月。应用电化学发光法检测血清中NT-proBNP水平,应用免疫荧光定量法检测血清中PCT水平,应用酶联免疫吸附法检测血清中IL-6水平。KD患儿使用静注人丙种球蛋白后比较NT-proBNP、IL-6、PCT的变化。采用χ^(2)检验、单因素方差分析、Mann-Whitney U检验、Kruskal-wallis H检验。结果对照组患儿血清NT-proBNP水平537.25(392.39,724.95)pg/ml低于典型组1340.00(924.50,3050.00)pg/ml和不典型组927.90(585.50,1499.50)pg/ml,差异均有统计学意义(均P<0.05),典型组和不典型组相比差异无统计学意义(P>0.05)。对照组患儿血清IL-6水平24.90(14.75,33.13)pg/ml低于典型组98.07(83.56,151.15)pg/ml和不典型组72.28(55.35,114.30)pg/ml,差异均有统计学意义(均P<0.05),典型组和不典型组相比差异无统计学意义(P>0.05)。对照组患儿PCT水平0.96(0.55,2.13)μg/L与不典型组0.24(0.14,0.50)μg/L、典型组0.40(0.29,0.74)μg/L比较,差异均有统计学意义(均P<0.05)。治疗后KD患儿NT-proBNP、IL-6水平较治疗前NT-proBNP、IL-6下降[365.10(205.73,736.35)pg/ml比1168.50(773.95,1972.25)pg/ml,15.55(5.83,46.32)pg/ml比91.70(69.24,136.67)pg/ml],差异均有统计学意义(均P<0.05);治疗后患儿PCT水平与治疗前比较差异无统计学意义[0.12(0.07,0.25)μg/L比0.33(0.17,0.58)μg/L](P>0.05)。结论NT-proBNP、IL-6、PCT疾病前期联合检测可作为辅助诊断0~6月龄小婴儿KD的重要参考指标。

Objective To study the expression levels of N-terminal B-type brain natriuretic peptide(NT-proBNP),procalcitonin(PCT),and interleukin-6(IL-6)in serum of 0-6 months old infants with Kawasaki disease(KD)and their clinical significance.Methods A total of 72 children with KD hospitalized in Children's Hospital Affiliated to Zhengzhou University from January 1,2018 to December 31,2020 were selected and were divided into a typical group(32 cases)and an atypical group(40 cases)according to the clinical manifestations and signs.And 30 non-KD children hospitalized with fever during the same period were selected as a control group.The level of NT-proBNP in serum was determined by electrochemiluminescence method,the level of PCT in serum was determined by immunofluorescence quantitative method,and the level of IL-6 in serum was determined by enzyme-linked immunosorbent assay.The changes of NT-proBNP,IL-6,and PCT in KD children were observed after intravenous injection of human gamma globulin.χ^(2) test,one-way analysis of variance,Mann-Whitney U test,and Kruskal-Wallis H test were used.Results The level of serum NT-proBNP in the control group was 537.25(392.39,724.95)pg/ml,which was lower than those in the typical group and the atypical group[1340.00(924.50,3050.00)pg/ml and 927.90(585.50,1499.50)pg/ml],with statistically significant differences(both P<0.05),but there was no statistically significant difference between the typical group and the atypical group(P>0.05).The level of serum IL-6 in the control group was 24.90(14.75,33.13)pg/ml,which was lower than those in the typical group and the atypical group[98.07(83.56,151.15)pg/ml and 72.28(55.35,114.30)pg/ml],with statistically significant differences(both P<0.05),but there was no statistically significant difference between the typical group and the atypical group(P>0.05).There were statistically significant differences in the PCT level among the control group[0.96(0.55,2.13)μg/L],the atypical group[(0.24(0.14,0.50)μg/L],and the typical group[0.40(0.29,0.74)μg/L],with statistically significant differences(all P<0.05).After treatment,the levels of NT-proBNP and IL-6 in children with KD decreased compared with those before treatment[365.10(205.73,736.35)pg/ml vs.1168.50(773.95,1972.25)pg/ml,15.55(5.83,46.32)pg/ml vs.91.70(69.24,136.67)pg/ml],with statistically significant differences(both P<0.05).There was no statistically significant difference in the level of PCT between before and after treatment[0.12(0.07,0.25)μg/L vs.0.33(0.17,0.58)μg/L](P>0.05).Conclusion NT-proBNP,IL-6,and PCT can be used as important reference indexes for the diagnosis of KD in infants aged 0-6 months in the early stage of the disease.