N末端脑钠肽前体、肌酸激酶同工酶MB与冠状动脉Z值联合检测在早期评估川崎病合并冠状动脉损伤的临床价值

Clinical Value of Combined N-terminal Pro-brain Natriuretic Peptide, Creatine Kinase-MB and Coronary Z Value in the Early Assessment of Kawasaki Disease Combined Coronary Artery Injury

目的探讨N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、肌酸激酶同工酶MB(creatine kinase-MB,CK-MB)与冠状动脉Z值联合检测对早期评估川崎病(Kawasaki disease,KD)合并冠状动脉病变(coronary artery lesions,CAL)的临床价值。方法回顾性收集2020-07/2022-12月在作者医院确诊为KD的64例患儿作为研究对象,根据是否发生CAL分为CAL组(n=11)和无CAL组(n=53),记录比较两组KD患儿右冠状动脉(right coronary artery,RCA)主干、左冠状动脉(left coronary artery,LCA)主干、左前降支(left anterior descending,LAD)和左回旋支(left circumflex artery,LCX)的Z值和血清中NT-proBNP与CK-MB的水平差异;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析冠脉Z值、NT-proBNP、CK-MB及三者联合检测KD合并CAL的诊断效能。结果CAL组RCA-Z值、LCA-Z值、LAD-Z值和LCX-Z值均大于无CAL组,组间比较差异有统计学意义(P<0.05);CAL组血清NT-proBNP、CK-MB均高于无CAL组,组间比较差异有统计学意义(P<0.05)。经ROC曲线分析,冠状动脉Z值诊断KD合并CAL的灵敏度为88.38%、特异度为82.12%,曲线下面积(area under the curve,AUC)值为0.864;NT-proBNP诊断KD合并CAL的灵敏度为84.78%、特异度为80.52%,AUC为0.831;CK-MB诊断KD合并CAL的灵敏度为83.59%、特异度为79.21%,AUC为0.810;三者联合诊断KD合并CAL的灵敏度为92.23%、特异度为89.47%,AUC为0.930,均高于单一诊断。结论NT-proBNP、CK-MB与冠状动脉Z值均在早期评估KD合并CAL中起到一定的诊断价值,但三者联合检测较单一检测明显提高诊断效能。

Objective To investigate the clinical value of joint detection of N-terminal pro-brain natriuretic peptide(NT-proBNP), creatine kinase-MB(CK-MB) and coronary Z value in the early assessment of Kawasaki disease(KD) combined coronary artery lesions(CAL). Methods A total of 64 children with KD diagnosed in author′s hospital from July 2020 to December 2022 were retrospectively collected and selected as the objects. The patients were divided into CAL group(n=11) and no CAL group(n=53) according to whether CAL occurred or not. The Z value of main right coronary artery(RCA), main left coronary artery(LCA), left anterior descending(LAD) and left circumflex artery(LCX) and serum levels of NT-proBNP and CK-MB were recorded and compared between the two groups;the diagnostic efficacy of coronary Z value, NT-proBNP, CK-MB and the combination of the three to detect KD combined CAL were analyzed by receiver operating characteristic(ROC). Results The RCA-Z value, LCA-Z value, LAD-Z value and LCX-Z value in the CAL group were higher than those in the no CAL group, and the differences between groups were statistically significant(P<0.05);the serum NT-proBNP and CK-MB in the CAL group were higher than those in the no CAL group, and the differences between the two groups were statistically significant(P<0.05). ROC curve analysis showed that the sensitivity and specificity of coronary Z value in the diagnosis of KD combined CAL were 88.38% and 82.12% respectively, and the area under the curve(AUC) value was 0.864;the sensitivity of NT-proBNP in the diagnosis of KD combined CAL was 84.78%, the specificity was 80.52% and the AUC value was 0.831;the sensitivity of CK-MB in the diagnosis of KD combined CAL was 83.59%, the specificity was 79.21%, and the AUC value was 0.810;the sensitivity, specificity and AUC of the combined diagnosis of KD combined CAL were 92.23%, 89.47% and 0.930 respectively, which were higher than those of single diagnosis. Conclusion NT-proBNP, CK-MB and coronary Z value can all play a certain diagnostic value in the early assessment of KD combined CAL, but the combination of the three tests can significantly improve the diagnostic efficacy and have a higher diagnostic value than a single test.