血小板分布宽度联合B型脑钠肽对川崎病患儿并发冠状动脉损害的预测

Predicting coronary artery damage in children with Kawasaki disease by using platelet distribution width combined with brain natriuretic peptide

目的探讨川崎病患儿急性期血小板分布宽度(PDW)联合B型脑钠肽(BNP),对是否发生冠状动脉损害(CAL)的评估。方法回顾性分析2019年10月—2021年12月本年院收治80例川崎病患儿的临床资料,根据冠状动脉超声检查结果将患儿分为非冠状动脉损害组(NCAL组,47例)和冠状动脉损害组(CAL组,33例)两组。选择同时间段因发热入院治疗的60例患儿作为对照组。比较各组受试儿童血清降钙素原(PCT)、C-反应蛋白(CRP)、血沉(ESR)、PDW、血浆D-二聚体(D-D)和BNP水平。结果CAL组、NCAL组患儿急性期PDW水平低于对照组,差异均存在统计学意义(P<0.05);CAL组、NCAL组患儿PCT、CRP、ESR、D-D和BNP水平均高于对照组,差异有统计学意义(P<0.05);CAL组患儿PDW水平低于NCAL组;CAL组患儿PCT、CRP、ESR、D-D和BNP水平均高于NCAL组,差异均存在统计学意义(P<0.05);采用logistic回归分析PDW降低、BNP升高均为川崎病并发CAL的独立危险因素。ROC曲线分析显示,PDW与BNP联合检测CAL灵敏度、特异度高于PDW、BNP单一检测,差异有统计学意义(P<0.05)。结论川崎病患儿急性期PDW水平明显降低,BNP水平明显升高,两者联合检测对川崎病患儿急性期发生CAL风险具有一定的评估价值的结论,研究具有实用性和创新性。

Objective To investigate the evaluation of predicting coronary artery injury(CAL)in children with Kawasaki disease at acute stage by using platelet distribution width(PDW)combined with brain natriuretic peptide(BNP).Methods The clinical data of 80 children with Kawasaki disease who were admitted to the affiliated hospital of Heze Medical College from October 2019 to December 2021 were retrospectively analyzed.According to the results of coronary artery ultrasound examination,the children were divided into non-coronary artery lesion(NCAL)group(n=47)and coronary artery lesion(CAL)group(n=33).Children hospitalized due to fever during the same period were selected as the control group(n=60).The levels of serum procalcitonin(PCT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and plasma D-dimer(D-D),PDW and BNP were compared among the three groups.Results The PDW levels in acute stage in CAL and NCAL group were significantly lower than that in control group,and the differences were statistically significant(P<0.05).The levels of PCT,CRP,ESR,D-D and BNP in CAL and NCAL group were significantly higher than those in control group,and the differences were statistically significant(P<0.05).The PDW level in CAL group was lower than that in non-CAL group.The PCT,CRP,ESR,D-D and BNP levels in CAL group were higher than those in non-CAL group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that both the decrease of PDW and elevation of BNP were independent risk factor for CAL in Kawasaki disease.ROC curve analysis showed that the sensitivity and specificity of combined detection of PDW and BNP in predicting CAL was higher than that of detecting PDW or BNP alone,and the difference was statistically significant(P<0.05).Conclusions The levels of PDW and BNP in children with Kawasaki disease at the acute stage were significantly decreased and significantly increased,respectively,indicating that the combined detection of the two indicators has certain value in assessing the risk of CAL in children with Kawasaki disease in the acute phase,and the study is practical and innovative.