血清氨基末端脑肽钠前体、心肌肌钙蛋白I联合检测对川崎病合并冠状动脉损害的早期诊断价值

Early diagnostic value of combined serum NT-proBNP and CTnI detection in Kawasaki disease complicated with coronary artery lesions

目的探讨血清氨基末端脑肽钠前体(NT-proBNP)、心肌肌钙蛋白I(CTnI)联合检测对川崎病合并冠状动脉损害(CAL)的早期诊断价值。方法选择2019年9月至2022年5月唐山市妇幼保健院收治的182例急性期川崎病病儿(川崎病组)和182例健康儿童(对照组)为研究对象,川崎病病儿根据入院时心脏超声检查结果分为CAL组(n=38)和无CAL(N-CAL)组(n=144)。比较各组血清NT-proBNP、CTnI水平;多因素logistic回归分析川崎病合并CAL的影响因素;血清NT-proBNP、CTnI对川崎病合并CAL的诊断效能采用受试者操作特征曲线(ROC曲线)。结果川崎病组血清NT-proBNP(204.96±41.37)ng/L、CTnI(5.78±0.82)μg/L水平均明显高于对照组[(48.52±7.18)ng/L、(1.94±0.16)μg/L](P<0.05)。CAL组病儿血清NT-proBNP(263.91±52.68)ng/L、CTnI(6.63±0.97)μg/L水平均明显高于N-CAL组[(189.40±38.39)ng/L、(5.56±0.78)μg/L](P<0.05)。logistic回归分析显示,发热时间、C反应蛋白、NT-proBNP、CTnI是影响川崎病病儿发生CAL的危险因素(P<0.05)。ROC曲线显示,血清NT-proBNP、CTnI及联合诊断川崎病病儿合并CAL的曲线下面积(AUC)及其95%CI分别为0.84(0.77,0.91)、0.81(0.74,0.89)、0.92(0.87,0.96)。结论川崎病合并CAL病儿血清NT-proBNP、CTnI水平升高,且二者与CAL密切相关,联合检测可以用于早期诊断CAL。

Objective To investigate the early diagnostic value of combined serum N terminal pro B type natriuretic peptide(NTproBNP)and cardiac troponin I(CTnI)for Kawasaki disease complicated with coronary artery lesions(CALs).Methods A total of 182 infants with acute-phase Kawasaki disease(Kawasaki disease group)and 182 healthy infants(control group)admitted to Tangshan Maternal and Child Health Hospital between September 2019 and May 2022 were selected as the study subjects,and the Kawasaki disease infants were divided into a CAL group(n=38)and a non-CAL(N-CAL)group(n=144)according to the results of the cardiac ultrasound examination at the time of hospital admission.The levels of serum NT-proBNP and CTnI in each group were compared;multivariate logistic regression was performed to analyze the factors influencing Kawasaki disease combined with CAL;and the diagnostic efficacy of serum NT-proBNP and CTnI for Kawasaki disease complicated with CAL was determined by using receiver operating characteristic(ROC)curve.Results The serum levels of NT-proBNP(204.96±41.37)ng/L and CTnI(5.78±0.82)μg/L in the Kawasaki disease group were greater than those in the control group[(48.52±7.18)ng/L,(1.94±0.16)μg/L](P<0.05).The serum levels of NT-proBNP(263.91±52.68)ng/L and CTnI(6.63±0.97)μg/L in the CAL group were greater than those in the N-CAL group[(189.40±38.39)ng/L,(5.56±0.78)μg/L](P<0.05).Logistic regression analysis revealed that fever duration,C-reactive protein,NT-proBNP,and CTnI were risk factors for the development of CALs in infants with Kawasaki disease(P<0.05).The ROC curve showed that the AUC and 95%CI for the serum NT-proBNP concentration,CTnI concentration,and combined diagnosis of combined CALs in infants with Kawasaki disease were 0.84(0.77,0.91),0.81(0.74,0.89),and 0.92(0.87,0.96),respectively.Conclusion The elevated serum levels of NT-proBNP and CTnI in the infants with Kawasaki disease complicated with CALs are closely related to CALs,and the combination of the two can be used for the early diagnosis of CALs.