川崎病患儿血清NT-proBNP、SAA、CRP、Cysc的表达及其联合检测对冠状动脉损害发生风险的预测效能研究

Expression of Serum NT-proBNP, SAA, CRP and Cysc in Children with Kawasaki Disease and its Predictive Efficacy Study of Combined Detection on the Risk of Coronary Artery Damage

目的:探讨川崎病(KD)患儿血清N末端B型利钠肽(NT-proBNP)、淀粉样蛋白A(SAA)、C反应蛋白(CRP)、胱抑素C(Cysc)的表达及其联合检测对冠状动脉损害(CAL)发生风险的预测效能。方法:纳入我院2019年1月到2021年12月期间收治的98例KD患儿,根据超声心动图检查结果分为CAL组(n=31)和无CAL组(n=67),对比两组血清NT-proBNP、SAA、CRP、Cysc水平差异。收集患者资料,采用Logistic多因素分析CAL发生的影响因素。绘制受试者工作特征(ROC)曲线分析血清NT-proBNP、SAA、CRP、Cysc联合检测对CAL发生风险的预测效能。结果:CAL组患儿的血清NT-proBNP、SAA、CRP、Cysc水平均高于无CAL组(P<0.05)。单因素分析结果显示:KD患儿并发CAL与年龄、治疗前发热时间、是否为典型KD以及血小板计数(PLT)、白细胞计数(WBC)水平有关(P<0.05)。多因素Logistic回归分析结果显示:血清NT-proBNP、SAA、CRP、Cysc、WBC水平较高、年龄<3岁、治疗前发热时间>6 d、非典型KD是KD患儿并发CAL的危险因素(P<0.05)。血清NT-proBNP、SAA、CRP、Cysc预测CAL发生的曲线下面积分别为0.761、0.759、0.753、0.746,四项联合检测预测CAL发生的曲线下面积为0.906,预测价值更高。结论:血清NT-proBNP、SAA、CRP、Cysc、WBC、年龄、治疗前发热时间、非典型KD是KD患儿并发CAL的影响因素,联合检测血清NT-proBNP、SAA、CRP、Cysc对CAL发生风险具有较好的预测效能。

Objective: To investigate the expression of serum N-terminal B-type natriuretic peptide(NT-proBNP), amyloid A(SAA), C-reactive protein(CRP) and cystatin C(Cysc) in children with Kawasaki disease(KD) and its prediction efficiency of combined detection on the risk of coronary artery damage(CAL). Methods: 98 children with KD who were treated in our hospital from January 2019 to December 2021 were included. According to the results of echocardiography, they were divided into CAL group(n=31) and non-CAL group(n=67). The levels difference of NT-proBNP, SAA, CRP and Cysc in the two groups were compared. The data of patients were collected, and the influencing factors of CAL were analyzed by Logistic multivariate analysis. The receiver operating characteristic(ROC) curve was drawn to analyze the predictive efficacy of the combined detection of serum NT-proBNP, SAA, CRP and Cysc on the risk of CAL. Results: The levels of serum NT-proBNP, SAA, CRP and Cysc in CAL group were higher than those in non-CAL group(P<0.05). Univariate analysis showed that CAL in children with KD was related to age, fever time before treatment, whether it was typical KD, platelet count(PLT) and leukocyte count(WBC)(P<0.05). Multivariate Logistic regression analysis showed that the high levels of serum NT-proBNP, SAA, CRP, Cysc and WBC, age < 3 years, fever time before treatment > 6 days and atypical KD were the risk factors of children with KD complicated with CAL(P<0.05). The areas under the curve of serum NT-proBNP, SAA, CRP and Cysc to predict the CAL occurrence were 0.761, 0.759, 0.753 and 0.746 respectively. The area under the curve of four joint tests to predict the CAL occurrence was 0.906, which has a higher predictive value. Conclusion: Serum NT-proBNP, SAA, CRP, Cysc, WBC, age, fever time be fore treatment and atypical KD are the influencing factors of CAL in children with KD. Combined detection of serum NT-proBNP,SAA, CRP and Cysc has a good prediction efficiency on the risk of CAL occurrence.