CRP、ESR、CKMB和BNP联合检测评估川崎病患儿合并冠脉病变的价值

The value of combined detection of CRP,ESR,CKMB and BNP in evaluating children with Kawasaki disease complicated with coronary artery lesions

目的 探究C反应蛋白(CRP)、红细胞沉降率(ESR)、肌酸激酶同工酶(CKMB)和脑利钠肽(BNP)联合检测在诊断川崎病(KD)合并冠脉病变(CAL)及其严重性的价值。方法 选择2018年1月至2022年5月于宁国市人民医院就诊的KD合并CAL患儿68例作为CAL组,选取同期未合并CAL的KD患儿60例作为NCAL组,比较两组CRP、ESR、CKMB、BNP水平,采用ROC曲线分析四项指标对CAL的诊断价值。根据冠状动脉病变严重程度将CAL组分为轻度亚组(n=25)、中度亚组(n=23)、冠状动脉瘤亚组(n=20),比较三组的CRP、ESR、CKMB、BNP水平,分析四项指标与冠脉病变严重程度关系。结果 CAL组的血小板计数、发热持续时间、CRP、ESR、CKMB、BNP水平均明显高于NCAL组,差异有统计学意义(t=2.948、3.690、9.155、4.733、26.423、8.133,P<0.05);Logistic回归分析显示,血小板计数、发热持续时间、CRP、ESR、CKMB、BNP是KD合并CAL的独立危险因素(OR=2.790、2.354、2.052、1.960、3.080、2.565,P<0.05);ROC曲线分析显示,四项指标联合诊断CAL的AUC为0.983,均高于单一的CRP、ESR、CKMB及BNP的0.816、0.783、0.864、0.843;随冠脉病变程度加重,CRP、ESR、CKMB和BNP水平逐渐升高,各组间比较差异均有统计学意义(F=259.977、10.934、178.849、79.599,P<0.05);CAL组患儿的CRP、ESR、CKMB和BNP水平与冠脉病变程度均呈正相关(r=0.712、0.618、0.659、0.634,P<0.05)。结论 CAL组患儿的CRP、ESR、CKMB、BNP水平均高于NCAL组,四项指标联合检测可辅助诊断KD合并CAL,并可提示冠脉病变严重程度。

Objective To explore the diagnostic value of combined detection of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),creatine kinase MB(CKMB)and brain natriuretic peptide(BNP)in coronary artery lesions(CAL)and its severity in children with Kawasaki disease(KD).Methods A total of 68 children with KD and CAL treated in Ningguo People's Hospital were enrolled as the CAL group from January 2018 to May 2022,while 60 KD children without CAL during the same period were enrolled as the NCAL group.The levels of CRP,ESR,CKMB and BNP were compared between the two groups.And their diagnostic value for CAL was analyzed by ROC curves.According to the severity of CAL,children in the CAL group were divided into the mild group(n=25),the moderate group(n=23)and the coronary aneurysm group(n=20),and levels of CRP,ESR,CKMB and BNP were compared among the three groups.The relationship between the four indicators and the severity of CAL was analyzed.Results The platelet count,duration of fever,levels of CRP,ESR,CKMB and BNP in the CAL group were significantly higher than those in the NCAL group(t=2.948,3.690,9.155,4.733,26.423,8.133,P<0.05).Logistic regression analysis showed that platelet count,duration of fever,CRP,ESR,CKMB and BNP were independent risk factors for KD combined with CAL(OR=2.790,2.354,2.052,1.960,3.080,2.565,P<0.05).ROC curves analysis showed that the AUC of the four indicators combined to diagnose CAL was 0.983,which was higher than that of CRP,ESR,CKMB and BNP alone(0.816,0.783,0.864,0.843).With the aggravation of CAL,the levels of CRP,ESR,CKMB and BNP were gradually increased,and differences among different groups were statistically significant(F=259.977,10.934,178.849,79.599,P<0.05).The levels of CRP,ESR,CKMB and BNP were positively correlated with the severity of CAL(r=0.712,0.618,0.659,0.634,P<0.05).Conclusion The levels of CRP,ESR,CKMB and BNP in the CAL group were higher than those in the NCAL group.The combined detection of the four indicators can assist in the auxiliary diagnosis of KD combined with CAL,and can indicate the severity of CAL.