N-末端脑钠肽前体联合炎性指标对川崎病并发冠状动脉损伤的诊断价值分析

Analysis on Diagnostic Value of N-Terminal Brain Natriuretic Peptide Precursor Combined with Inflammatory Indicators in Kawasaki Disease Complicated with Coronary Artery Lesion

目的:探讨N-末端脑钠肽前体(NT-proBNP)联合炎性指标对川崎病(KD)并发冠状动脉损伤(CAL)的诊断价值。方法:选取2019年7月-2020年6月郴州市第一人民医院收治的99例KD患儿作为KD组,根据疾病时期分为KD急性组与KD缓解组,根据有无CAL分为CAL组(19例)和无CAL组(NCAL组,80例);并选取同期58例发热患者作为对照组。分析血清中NT-proBNP、全血白细胞(WBC)数、中性粒细胞百分比(Neu%)、血小板计数(PLT)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、系统性免疫-炎症指数(SII)在KD急性期、缓解期及CAL中的变化,分析NTproBNP联合各项炎性指标对KD伴CAL的诊断价值。结果:KD组WBC、Neu%、PLT、NLR、PLR、SII、NT-proBNP均高于对照组,差异有统计学意义(P<0.05);KD急性组WBC、Neu%、NLR、SII、NT-proBNP均高于KD缓解组,PLT低于KD缓解组,差异有统计学意义(P<0.05);KD急性组与KD缓解组PLR比较,差异无统计学意义(P>0.05)。CAL组PLT、SII、NT-proBNP水平均高于NCAL组,差异有统计学意义(P<0.05);CAL组与NCAL组WBC、Neu%、NLR、PLR比较,差异无统计学意义(P>0.05)。ROC曲线下面积(AUC)分析发现NT-proBNP、PLT、SII 3项联合指标均为KD伴CAL的有效预测指标,且联合指标对CAL的诊断效能优于PLT及SII单独检测,差异有统计学意义(P<0.05);与NT-proBNP诊断效能比较,差异无统计学意义(P>0.05);灵敏度高于NT-proBNP。结论:NT-proBNP联合PLT及SII对CAL具有较高的诊断效能,可为其早期诊断提供依据。

Objective:To explore the diagnostic value of the combination of N-terminal brain natriuretic peptide precursor(NTproBNP)and various inflammatory indicators in Kawasaki disease(KD)complicated with coronary artery lesion(CAL).Methods:From July 2019 to June 2020,99 KD children who were admitted to Chenzhou First People’s Hospital were selected as the KD group,and they were divided into KD acute group and KD remission group according to the disease phase,and coronary artery lesion group(CAL group:19 cases)and non-coronary artery lesion group(NCAL group:80 cases)according to the presence/absence of coronary artery injury.During the same period,58 febrile patients were selected as the control group.The changes of NT-proBNP,complete blood white blood cell count(WBC),percentage of neutrophils(Neu%),platelet count(PLT),neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)at KD acute phase,remission phase and CAL were analyzed.The diagnostic value of NT-proBNP combined with various inflammatory indicators in KD with CAL was analyzed.Results:There were no significant differences in gender and age between KD group and control group(P>0.05).WBC,Neu%,PLT,NLR,PLR,SII,NT-proBNP in the KD group were higher than those in the control group,and the difference was statistically significant(P<0.05).WBC,Neu%,NLR,SII,NT-proBNP in the KD acute group were higher than those in the KD remission group,and the PLT in the KD acute group was lower than that in the KD remission group,and the difference was statistically significant(P<0.05).There was no significant difference in PLR between the two groups(P>0.05).The levels of PLT,SII,NT-proBNP in the CAL group were higher than those in the NCAL group,and the difference was statistically significant(P<0.05).There was no significant difference in WBC,Neu%,NLR and PLR between the two groups(P>0.05).The area under the ROC curve(AUC)analysis showed that the three combined indicators of NT-proBNP,PLT and SII were all effective predictors of KD with CAL,and the diagnostic efficiency of the combined indicators for CAL was better than that of PLT and SII alone,and the difference was statistically significant(P<0.05).Compared with NT-proBNP,there was no significant difference in diagnostic efficiency(P>0.05).The sensitivity was higher than that of NT-proBNP.Conclusion:NT-proBNP combined with PLT and SII has a high diagnostic efficiency for CAL and can provide a basis for early diagnosis.