血浆N末端脑利钠肽原和血清白蛋白在早期诊断不完全川崎病中的临床价值  

The clinical value of plasma N-terminal pro-brain natriuretic peptide and serum albumin in the early diagnosis of incomplete Kawasaki＇s disease

作　　者：狄亚珍[1] 吴菱[1] 李蕴言[1] 马田瑞[1] 王天波[1] 林亚红[1] 戴霞华[1] 

机构地区：[1]浙江省宁波市妇女儿童医院小儿风湿免疫科,315012

出　　处：《中华风湿病学杂志》2013年第9期595-600,共6页Chinese Journal of Rheumatology

基　　金：浙江省医药卫生科学研究基金（20088168）

摘　　要：目的观察川崎病、不完全川崎病（IKD）和发热原因不明患儿血浆N末端脑利钠肽原（NT-proBNP）、血清白蛋白的表达水平，探讨血NT—proBNP、白蛋白水平在早期诊断IKD中的临床意义。方法应用酶联荧光分析（ELFA）技术测定246例川崎病患儿（川崎病组）、61例IKD患儿（IKD组）及301例入院时发热原因不明患儿（发热组）入院当天血浆NT-proBNP水平，同时观察血白蛋白等水平。川崎病、IKD患儿行心电图及超声心动图检查，根据检查结果分心血管损害组及无心血管损害组。对各组间检测指标比较应用t检验或方差分析，各检测指标间关系用Pearson相关分析，对有统计学意义的NT-proBNP值进行受试者工作特征曲线（ROC）分析，获得鉴别心血管损害的最佳临界值。结果①川崎病组、IKD组血浆NT-proBNP水平明显高于发热组[（789．1±4．7）、（824．8±4．4）和（92．5±2．3）ng／L，F=230．736，P均〈0．05]。②川崎病组、IKD组血白蛋白水平明显低于发热组[（33．9±2．8）、（33．8±3．1）和（40．8±3．6）g／L，F=355．648，P均〈0．05]。③川崎病组、IKD组中心血管损害组与无心血管损害组血浆NT．proBNP水平比较，川崎病组：（2948_±3）g／L（103例）和（307±3）g／L（143例）；IKD组：（1454±4）g／L（38例）和（323±4）g／L（23例）；差异均有统计学意义（t=16．464、4．356，P均〈0．05）。④当血浆NT—proBNP水平≥933．5ng／L时，鉴别川崎病、IKD患儿是否存在心血管损害的敏感性为88．1％，特异性为89％。⑤当血浆NT-proBNP〉250ng／L时诊断川崎病、IKD的敏感性分别为80．9％、85．2％，特异性均为85．7％。当同时满足血浆NT-proBNP〉250ng／L及血白蛋白〈35g／L时诊断川崎病、IKD的敏感性分别为67．5％、70．5％，特异性均为99．7％。结论血浆NT-proBNP水平升高（〉250ng／L）同时伴白蛋白下降（�Objective To study the expression levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）, serum albumin of Kawasaki＇s disease （KD）, incomplete Kawasaki＇s disease （IKD）, and children whose fever were unexplained and to explore the clinical significance of the levels of NT-proBNP and serum albumin in the early diagnosis of IKD. Methods The levels of NT-proBNP of 246 cases of KD （KD group）, 61 cases of IKD （IKD group） and 301 cases of children with unexplained fever （fever group） were measured by the enzyme-linked fluorescence analysis （ELFA） at the day of admission, meanwhile, the levels of albumin were tested in KD, and IKD children were underwent ECG and echocardiography. Based on the test results, patients were further divided into the group with cardiovascular damage and the group without cardiovascular damage. SPSS 19.0 was used for statistical analysis. The t test was used to compare the parameters between each group, the variance analysis and association analysis were carried out with Pearson＇s correlation analysis. The ROC curve analysis was done to identify the cardiovascular damage threshold. Results ① The level of plasma NT-proBNP of the KD group, the IKD group was significantly h igher than the fever group [（789.1±4.7） ng/L, （824.8±4.4） ng/L vs （92.5±2.3） ng/L, F=230.736, all P〈0.05]; ② The level of albumin of the KD group and the IKD group was significantly lower than that of the fever group [（33.9±2.8） g/L, （33.8±3.1） g/L vs （40.8±3.6） g/L, F=355.648, all P〈0.05]; ③） The levels of NT-proBNPs between the cardiovascular damage group and the groups without cardiovascular damage among the KD group, and those of the IKD groups were compared. In the KD group, thg NT-proBNPs level of the two subgroups was （2948±3） g/L （n=103） vs （305±3） g/L, n=143; while inthe IKD group, the NT-proBNPs of the two subgroups was （1454±4） g/L （n=38） vs （323±4） g/L （n=23）. The dif-ferences were statistically signif

关 键 词：利钠肽 脑 血清白蛋白 早期诊断 黏膜皮肤淋巴结综合征 

分 类 号：R725.4[医药卫生—儿科]