血细胞参数及ANCA 在川崎病早期诊断中的研究

Blood cell parameters and anti-neutrophil cytoplasmic antibody in the diagnosis of early Kawasaki disease

目的:探讨外周血细胞参数及抗中性粒细胞胞浆抗体(ANCA)在川崎病(KD)早期诊断中的价值。方法:采用单中心回顾性队列研究,将符合要求的95例KD初诊患儿作为研究对象,选取同时期年龄和性别均相匹配的45例肺炎患儿和45例健康儿童分别作为肺炎组和健康组,对3组儿童进行ANCA和C反应蛋白(CRP)的血清学检测,检测并计算血细胞中中性粒细胞-淋巴细胞绝对值比值(NLR)、血小板-淋巴细胞绝对值比值(PLR)、平均血小板体积-淋巴细胞绝对值比值(MPVLR),利用受试者工作特征曲线(ROC)评估NLR、PLR、CRP在KD早期诊断中的价值。结果:①60.0%的KD患儿早期ANCA检测阳性,明显高于肺炎组和健康组。②KD患儿的早期NLR、PLR及CRP较肺炎组和健康组升高,而各组间MPVLR差异无统计学意义。③ROC曲线分析,NLR、PLR及CRP诊断KD的最佳阈值分别为1.35、88.87、20.6,其对应的灵敏度分别为0.947%、0.958%、0.926%,特异度分别为0.844%、0.667%、0.711%,曲线下面积分别为0.947、0.876、0.850。结论:NLR、PLR、CRP及ANCA在KD中有较高水平;ROC曲线分析提示NLR、PLR及CRP可作为KD早期诊断的预测指标。

Objective:To investigate the values of peripheral blood cell parameters and anti-neutrophil cytoplasmic antibody(ANCA)in the diagnosis of Kawasaki disease(KD)at early stage.Methods:Single-center retrospective cohort study was conducted in 95 patients initially diagnosed as KD.Forty-five children with age and gender matched,diagnosed with pneumonia at the corresponding period,and another 45 healthy children were respectively recruited as observational and control subjects.The children in the three groups received measurement of ANCA and C-reactive protein(CRP).The absolute neutrophil-lymphocyte count ratio(NLR)and platelet-lymphocyte count ratio(PLR)as well as absolute mean platelet volume-lymphocyte count ratio(MPVLR)in peripheral blood were detected and calculated.Receiver operating characteristic(ROC)curve was used to analyze the predictive values of NLR,PLR and CRP in the early diagnosis of KD.Results:①Positive ANCA was found in 60%of the children with KD,which was significantly higher than that of the pneumonia group and the healthy group;②The NLR,PLR and CRP were significantly higher in children with KD than those of the pneumonia group and healthy group,yet there was no statistical difference in MPVLR;③ROC curve analysis indicated that the best threshold of NLR,PLR and CRP for diagnosing KD was 1.66,68.87 and 20.6,respectively.The sensitivity and specificity were 0.868,0.934 and 0.882,and 0.752,0.541 and 0.569,respectively.The area under ROC was 0.843,0.786 and 0.752.Conclusion:NLR,PLR,CRP and ANCA levels are relatively higher in children of KD.ROC analysis further confirms that than those of the pneumonia group and the healthy group.ROC curve analysis indicates that NLR,PLR and CRP can serve as indicators for diagnosis of KD at its early stage.