肝功异常川崎病患儿发生冠状动脉损伤直接危险因素分析

An Analysis of Direct Risk Factors for Coronary Artery Lesion inChildren with Abnormal Liver Function in Kawasaki Disease

目的探讨肝功异常川崎病患儿发生冠状动脉损伤(CAL)的直接危险因素。方法选择2020年9月至2022年8月在青岛市妇女儿童医院就诊的96例川崎病患儿作为实验组,根据谷丙转氨酶(ALT,ALT>50U/L为肝功异常)分为肝功正常组50例和肝功异常组46例;选择58例同期同年龄段呼吸科肺炎患儿作为对照组。对3组患儿均进行C-反应蛋白(CRP)、D-二聚体(D-D)、高密度脂蛋白胆固醇(HDL-C)、N端脑钠肽前体(NT-proBNP)的检测;同时对实验组进行超声心动图检查,比较川崎病两组之间CAL发生的比率。结果实验组患儿CRP、D-D、NT-proBNP的水平均明显高于对照组,HDL-C明显低于对照组(Z/t=603.00、588.00、48.00、6.65,均P<0.05);肝功异常组患儿CRP、D-D、NT-proBNP的水平均明显高于肝功正常组,HDL-C明显低于肝功正常组(Z/t=682.50、408.00、487.00、3.13,均P<0.05);超声心动图结果显示肝功异常组CAL发生率明显高于肝功正常组(χ2=5.16,P<0.05)。CRP、D-D、NT-proBNP及HDL-C水平预测肝功异常川崎病患儿并发CAL的ROC曲线结果显示,AUC分别为0.70、0.71、0.72、0.73;最佳临界值分别为64.88mg/L、2.05mg/L、1148.62pg/mL、0.66mmol/L;灵敏度分别为0.54、0.70、0.63、0.74;特异性分别为0.88、0.82、0.80、0.72;4个指标联合检测的AUC为0.84,灵敏度为0.89,特异性为0.63。结论CRP、D-D、NT-proBNP升高,HDL-C降低与川崎病发生密切相关;上述4个指标的变化可作为预测肝功异常川崎病患儿并发CAL的直接危险因素,且联合检测可提高诊断及预测价值。

Objective To investigate the direct risk factors of coronary artery injury(CAL)in children with abnormal liver function in Kawasaki disease(KD).Methods 96 KD children admitted to Qingdao Women and Children’s Hospital from September,2020 to August,2022 were selected as the experimental group.According to ALT(ALT>50 U/L was considered as abnormal liver function),these patients were divided into 50 cases with normal liver function and 46 cases with abnormal liver function.58 children with respiratory pneumonia with the same age and period were selected as the control group.The levels of C-reactive protein(CRP),D-Dimer(D-D),high density lipoprotein cholesterol(HDL-C)and N-terminal pro-brain natriuretic peptide(NT-proBNP)were detected in all three groups,and echocardiography was performed in the experimental group to compare the incidence rate of coronary artery lesion between the abnormal liver function group and the normal liver function group.Results The levels of CRP,D-D and NT-proBNP in the experimental group were significantly higher than those in the control group;HDL-C was significantly lower than that in the control group(Z/t=603.00,588.00,48.00,6.65,all P<0.05).The levels of CRP,D-D and NT-proBNP in KD children with abnormal liver function were significantly higher than those with normal liver function;HDL-C was significantly lower than that with normal liver function(Z/t=682.50,408.00,487.00,3.13,all P<0.05).The results of echocardiography showed that the incidence rate of coronary artery lesion in abnormal liver function group was significantly higher than that in normal liver function group(χ2=5.16,P<0.05).ROC analysis showed that the area under the curve(AUC)of CRP,D-D,NT-proBNP and HDL-C for predicting CAL in KD children with abnormal liver function were 0.70,0.71,0.72 and 0.73;the cut-off value were 64.88mg/L,2.05mg/L,1148.62pg/mL and 0.66mmol/L;the sensitivity were 0.54,0.70,0.63 and 0.74;the specificity were 0.88,0.82,0.80 and 0.72 respectively;AUC of four indicators combined detection was 0.84,with the sensitivity and specificity of 0.89 and 0.63 respectively.Conclusion CRP,D-D,and NT-proBNP increase and HDL-C decrease are closely related to the occurrence of Kawasaki disease.The changes of the above four indicators are the direct risk factors which predict the occurrence of CAL in KD children with abnormal liver function,and combined detection can improve the diagnostic and predictive value.