N端脑钠肽前体与超声心动图对川崎病的早期诊断对比研究  

Comparison of N-terminal pro-brain natriuretic peptide and echocardiography in the early diagnosis of Kawasaki disease

作　　者：杨芳[1] 王晓莉 欧宓[2] 韩莉莉[3] Yang Fang;Wang Xiaoli;Ou Mi;Han Lili(Department of Pediatrics,Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Department of Echocardiography,Fujian Provincial Hospital,Fuzhou 350001,China;Immunology Laboratory,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院儿科,福州350001 [2]福建省立医院心脏超声科,福州350001 [3]福建省立医院免疫实验室,福州350001

出　　处：《中华实用儿科临床杂志》2019年第23期1803-1806,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：福建省卫生厅青年科研基金(2007-1-18)。

摘　　要：目的比较N端脑钠肽前体(NT-proBNP)与超声心动图在川崎病(KD)早期诊断中的意义.方法收集2013年1月至2017年12月在福建省立医院儿科住院诊断为KD患儿入院时的病程、入院时NT-proBNP值及超声心动图检测冠状动脉情况,采用配对四格表资料x^2检验比较NT-proBNP与超声心动图对KD早期诊断的意义.结果典型川崎病(TKD)154例,入院时病程≤7d者104例,NT-proBNP≥300 ng/L者90例,超声心动图提示冠状动脉损害14例,其中NT-proBNP≥300 ng/L且超声心动图提示冠状动脉损害13例,NT-proBNP增高的阳性率高于冠状动脉损害的阳性率,差异有统计学意义(x^2=74.05,P<0.05);入院时病程8~11 d 44例,NT-proBNP≥300 ng/L 7例,超声心动图提示冠状动脉损害8例,其中NT-proBNP≥300 ng/L且超声心动图提示冠状动脉损害3例,NT-proBNP增高的阳性率与冠状动脉损害的阳性率比较,差异无统计学意义(x^2=0,P>0.05);入院时病程12~21 d者6例,NT-proBNP≥300 ng/L 0例,超声心动图提示冠状动脉损害3例,NT-proBNP增高的阳性率与冠状动脉损害的阳性率比较,差异无统计学意义(x^2=0,P>0.05).不完全川崎病(IKD)102例,入院时病程≤7 d者69例,NT-proBNP≥300 ng/L 56例,超声心动图提示冠状动脉损害6例,其中NT-proBNP≥300 ng/L且超声心动图提示冠状动脉损害6例,NT-proBNP增高的阳性率高于冠状动脉损害的阳性率,差异有统计学意义(x^2=50.00,P<0.05);入院时病程8~11 d者29例,NT-proBNP≥300 ng/L 5例,超声心动图提示冠状动脉损害4例,NT-proBNP增高的阳性率与冠状动脉损害的阳性率比较,差异无统计学意义(x^2=0,P>0.05);入院时病程在12~21 d 4例,NT-proBNP≥300 ng/L者0例,超声心动图提示冠状动脉损害者2例,NT-proBNP增高的阳性率与冠状动脉损害的阳性率比较,差异无统计学意义(x^2=0,P>0.05).结论NT-proBNP可作为KD患儿早期诊断的指标,且诊断效果优于超声心动图.Objective To compare the differences between roles of N-terminal pro-brain natriuretic peptide(NT-proBNP)levels and that of echocardiography in early diagnosis of Kawasaki disease(KD).Methods Medical records of patients with KD at the Department of Pediatrics,Fujian Provincial Hospital from January 2013 to December 2017 were collected retrospectively.The levels of NT-proBNP and the echocardiographic parameters on admission were compared between patients with varying days of fever by the Chi-squared test.Results A total of 154 patients with typical KD(TKD)were identified.Among them,104 cases had fever≤7 days on admission,90 cases out of them with NT-proBNP≥300 ng/L,14 cases with coronary artery lesion detected by echocardiography,and 13 cases with positive findings in both NT-proBNP and echocardiography.For patients having≤7 days of fever,the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination(x^2=74.05,P<0.05).Forty-four cases had 8-11 days of fever,and among them 7 cases with NT-proBNP≥300 ng/L,8 cases with coronary artery lesion,3 cases with two indexes positive.For patients with 8-11 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography(x^2=0,P>0.05).Among 6 total cases who had 12-21 days of fever,3 cases had coronary artery lesion,none with NT-proBNP≥300 ng/L.For patients with 12-21 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography(x^2=0,P>0.05).A total of 102 cases with incomplete KD(IKD)were enrolled,and among them of 69 cases had fever≤7 days on admission,56 cases with NT-proBNP≥300 ng/L,6 cases with coronary artery lesion,and 6 cases with positive findings in both indexes.For IKD patients with≤7 days of fever,the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination(x^2=50.00,P<0.05).Twenty-nine cases had 8-11 days of fever,and among them 5 cases with NT-proBNP≥300 ng/L,4 cases w

关 键 词：川崎病 N端脑钠肽前体 超声心动图 早期诊断 

分 类 号：R72[医药卫生—儿科] R54[医药卫生—临床医学]