血栓调节蛋白在川崎病患儿早期诊断及预后评估中的价值  

The value of thrombomodulin in early diagnosis and prognosis evaluation of children with Kawasaki disease

作　　者：张聪[1] 张洁[1] 张林[1] 刘利敏[2] 黄彩芝[1] ZHANG Cong;ZHANG Jie;ZHANG Lin;LIU Limin;HUANG Caizhi(Center of Clinical Laboratory,Hunan Children′s Hospital,Changsha,Hunan 410007,China;Department of Emergency Observation Transfusion,Hunan Children′s Hospital,Changsha,Hunan 410007,China)

机构地区：[1]湖南省儿童医院检验中心,湖南长沙410007 [2]湖南省儿童医院急诊留观输液科,湖南长沙410007

出　　处：《国际检验医学杂志》2022年第21期2569-2572,2577,共5页International Journal of Laboratory Medicine

基　　金：湖南省自然科学基金项目(2017JJ2140)。

摘　　要：目的探讨血栓调节蛋白(TM)、凝血功能指标[血小板计数(PLT)、纤维蛋白原(FIB)、D二聚体(D-D)]和炎症标志物[白细胞计数(WBC)与C反应蛋白(CRP)]在川崎病早期诊断、治疗监测及预后评估中的临床价值。方法选择2020年1月至2021年3月在该院住院的205例川崎病患儿为观察组,根据入院时静脉注射免疫球蛋白(IVIG)治疗前的超声心动图结果分为合并冠状动脉病变(CAL)组与未合并冠状动脉病变(NCAL)组,其中CAL组患儿按出院后随访2个月时的超声心动图的结果进一步分为预后良好组(已无CAL)与预后不良组(仍有CAL)。随机选取同期在该院儿保科进行体检的健康儿童50例作为对照组。对各组儿童的TM、炎症标志物(WBC与CRP)、凝血功能指标(PLT、FIB、D-D)进行检测与分析。结果观察组入院时的WBC、CRP、FIB、D-D、PLT、TM水平均高于对照组,差异均有统计学意义(P<0.05)。与入院时比较,治疗后川崎病患儿WBC、CRP、FIB、D-D水平明显降低,而PLT与TM水平明显升高,差异有统计学意义(P<0.05)。在205例川崎病患儿中,发生CAL的有30例(14.6%),未发生CAL的有175例(85.4%),CAL组与NCAL组入院时的WBC、PLT、CRP、FIB、D-D、TM水平比较,差异均无统计学意义(P>0.05)。而川崎病合并CAL患儿中,预后不良组的TM水平[3.8(2.2~4.9)ng/mL]明显高于预后良好组[1.6(0.9~3.7)ng/mL],差异有统计学意义(P<0.05)。受试者工作特征曲线显示TM为2.64 ng/mL时,预测川崎病患儿预后不良的曲线下面积为0.72(0.53~0.90),灵敏度为73.3%,特异度为66.7%。结论TM、炎症标志物(WBC、CRP)与凝血功能指标(FIB、D-D、PLT)可作为川崎病患儿的早期辅助诊断指标,TM水平升高可能预测川崎病合并CAL患儿预后不良。Objective To explore the clinical value of thrombomodulin(TM),coagulation function indicators[platelet count(PLT),fibrinogen(FIB)and D-dimer(D-D)]and inflammatory markers[white blood cell count(WBC)and C-reactive protein(CRP)]in early diagnosis,treatment monitoring and prognosis evaluation in Kawasaki disease.Methods A total of 205 children with Kawasaki disease in Hunan Children′s Hospital from January 2020 to March 2021 were selected into observation group.According to the results of echocardiography before immune globulin(IVIG)treatment,they were divided into group with coronary artery disease(CAL group)and group without coronary artery disease(NCAL group).The CAL group was further divided into good prognosis group(without CAL)and poor prognosis group(with CAL)according to the results of echocardiography at 2-month follow-up after discharge.Other 50 healthy children who underwent physical examination in this hospital during the same period were randomly selected as the control group.All of the children′s TM,inflammatory markers(WBC and CRP),coagulation function indicators(PLT,FIB and D-D)were detected and analyzed respectively.Results The levels of WBC,CRP,FIB,D-D,PLT and TM in observation group on admission were higher than those in control group,the differences were statistically significant(P<0.05).Compared with those at admission,the levels of WBC,CRP,FIB and D-D of patients with Kawasaki disease decreased significantly after treatment,while the levels of PLT and TM increased significantly(all P<0.05).Among 205 children with Kawasaki disease,30 cases(14.6%)had CAL,while 175 cases(85.4%)had no CAL.There was no significant difference on WBC,PLT,CRP,FIB,D-D and TM between CAL group and NCAL group at admission(P>0.05).Among Kawasaki disease with CAL patients,the TM level in poor prognosis group[3.8(2.2-4.9)ng/mL]was significantly higher than that in good prognosis group[1.6(0.9-3.7)ng/mL],the difference was statistically significant(P<0.05).When TM was 2.64 ng/mL,the area under receiver operating character

关 键 词：川崎病 冠状动脉病变 儿童 血栓调节蛋白 

分 类 号：R446.1[医药卫生—诊断学]