血N末端脑利钠肽原及高密度脂蛋白胆固醇对川崎病心血管损害预测价值的研究  

The predictive value of blood N-terminal pro-brain natriuretic peptide and high density lipoprotein cholesterol for cardiovascular damage in Kawasaki disease

作　　者：狄亚珍[1] 吴菱[1] 钟世玲 李蕴言[1] 陈圆玲[1] 戴霞华[1] 林亚红[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》2014年第3期170-175,I0001,共7页Chinese Journal of Rheumatology

基　　金：浙江省医药卫生科学研究基金（2008B168）

摘　　要：目的探讨血N末端脑利钠肽原（NT-proBNP）、HDL—C在预测川崎病心血管损害中的价值。方法应用酶联荧光分析（ELFA）技术分别测定406例川崎病患儿[其中不完全川崎病（IKD）患儿104例]急性期、恢复期的血NT—proBNP水平，同时观察血HDL—C、白蛋白、球蛋白、ALT、CRP、ESR、白细胞计数、血红蛋白、血小板计数水平；再根据超声心动图、心电图、心肌酶谱结果将川崎病患儿分为心血管损害组222例及心血管无损害组184例，对2组患儿的年龄、性别、热程、首次应用静脉注射用丙种球蛋白时间、临床特征及以上检测的实验室指标水平进行比较，比较采用f检验或r检验，对差异有统计学意义的单因素进行受试者工作特征曲线（ROC）分析；再将心血管损害组分为超声心动图异常组及超声心动图正常组，采用t检验比较2组的临床指标。结果①406例川崎病患儿中心血管损害组与心血管无损害组间年龄、唇及口腔改变、首次应用静脉丙种球蛋白时间、血NT-proBNP、HDL—C、白蛋白、ALT水平差异有统计学意义（t/χ2=4．989、4．721、6．212、18．834、12．788、4．851、4．541，P均〈0．05）。②当血NT—proBNP≥786．5ng／L时，鉴别川崎病患儿是否存在心血管损害的敏感性为86．5％，特异性为84．8％；当血HDL－C〈0．655mmol／L时，鉴别川崎病患儿是否存在心血管损害的敏感性为80．4％，特异性为69．4％；当同时满足血NT．DroBNP≥786．5ng／L及HDL-C〈0．655mmol／L时鉴别川崎病患儿是否存在心血管损害的特异性为91．8％。③222例心血管损害的川崎病患儿中超声心动图异常组及超声心动图正常组间血NT-proBNP、HDL．C水平差异有统计学意义（t=3．354、4．084，P均〈0．05）。④406例川崎病患儿急性期与恢复期实验室指标比较，血NT-proBNP、ALT水平急性期明显高于恢复期，血HDL—C、白蛋白水平�Objective To observe the levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）, high density lipoprotein cholesterol （HDL-C） in predicting cardiovascular damage in Kawasaki disease （KD）. Methods Enzyme-linked fluorescence analysis （ELFA） technique was used to measure serum NT-proBNP levels in 406 KD patients [including 104 cases of incomplete Kawasaki disease （IKD）] at the acute phase, the convalescent stage, at the same time, the blood HDL-C, Albumin, globulin, alanine aminotransferase （ALT）, C-reactive protein （CRP）, red blood cell sedimentation rate （ESR）, blood white cell count （WBC）, hemoglobin （Hb）, blood platelet count （PLT） level were tested. According to the results of echocardiography, electrocardiogram, myocardial enzymes in KD, patients were divided into two groups： two hundred and twenty-two with cardiovascular damage and 184 without cardiovascular damage group. The age, gender, fever, the first application of the intravenous gamma globulin, laboratory markers of clinical features observed above the detection levels were compared, and these parameters for each group were compared using t test or analysis of variance, the single factor which was statistically significant were received operating characteristic curve （ROC） analysis. Then the cardiovascular damage group was divided into echocardiography abnormal group and echocardiography normal group, and t test was adopted to compare the clinical parameters of the two groups. Results ① The age, lip and oral changes, the first application of intravenous gamma globulin, blood NT-proBNP, HDL-C, albumn and ALT was significantly different between the cardiovascular damage group and non cardiovascular damage group （t/χ2=4.989, 4.721, 6.212, 18.834, 12.788, 4.851, 4.541, All P〈0.05）. ② When the blood NT-pro-BNP was higher than 786.5 ng/L, its sensitivity and specificity for differ- entiating KD with cardiovascular damage was 86.5% and 84.8%, respectively. When the blood HDL-C was lower than

关 键 词：利钠肽 脑 脂蛋白类 HDL胆固醇 黏膜皮肤淋巴结综合征 心血管疾病 

分 类 号：R725.4[医药卫生—儿科]