川崎病患儿血浆YKL-40、CRP、IL-6对急性期冠状动脉损伤的诊断价值  

Diagnostic value of plasma YKL-40, CRP, IL-6 in acute coronary artery injury in children with Kawasaki disease

作　　者：闵丽 袁时健 刘亚红[1] 王晋[1] 牛少敏[1] 杨轶男[1] 董湘玉[1] Min Li;Yuan Shijian;Liu Yahong;Wang Jin;Niu Shaomin;Yang Yinan;Dong Xiangyu(Department of Pediatrics,Lanzhou University Second Hospital,Gansu Province,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院儿科,730030

出　　处：《疑难病杂志》2023年第4期367-372,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：甘肃省自然科学基金项目(17JR5RA222)。

摘　　要：目的分析川崎病(KD)患儿血浆人软骨糖蛋白-39(YKL-40)、C反应蛋白(CRP)、白介素-6(IL-6)对冠状动脉损伤(CAL)的诊断价值。方法选取2018年4月1日—2021年12月31日兰州大学第二医院儿科收治KD患儿125例为KD组,根据是否合并CAL再分为CAL亚组53例及NCAL亚组72例,另选择同期性别及年龄相匹配的健康体检儿童125例作为健康对照(HC)组及因消化道感染发热患儿125例作为发热对照(FC)组。收集各组临床资料,检测所有受试儿童血浆YKL-40、CRP、IL-6水平。多因素Logistic回归分析KD患儿发生CAL的危险因素,受试者工作特征曲线(ROC)分析血浆YKL-40、CRP、IL-6诊断KD患儿发生CAL的价值。结果血浆YKL-40、CRP、IL-6水平比较,KD组>FC组>HC组(F/P=296.352/<0.001、35.162/<0.001、20.266/<0.001)。CAL亚组血浆YKL-40、CRP、IL-6水平高于NCAL亚组(t/P=7.434/<0.001、7.967/<0.001、7.444/<0.001);CAL亚组静注免疫球蛋白(IVIG)治疗前热程及IVIG无应答、IVIG开始时间≥10 d比例高于NCAL亚组[t(χ^(2))/P=6.831/<0.001、8.304/0.004、3.953/0.047]。多因素Logistic回归分析显示,IVIG无应答、YKL-40高、CRP高、IL-6高是KD患儿发生CAL的危险因素[OR(95%CI)=4.627(2.072~10.336)、1.441(1.128~1.840)、1.540(1.106~2.145)、1.343(1.098~1.644)]。ROC曲线分析显示,血浆YKL-40、CRP、IL-6及三者联合诊断KD患儿发生CAL的曲线下面积为0.813、0.846、0.821、0.923,三者联合诊断效能高于单独指标诊断(Z/P=2.965/0.012、2.536/0.020、2.308/0.025)。结论KD患儿血浆YKL-40、CRP、IL-6水平均增高,且与KD患儿并发CAL有关,联合三项指标在KD患儿发生CAL诊断中具有较高价值。Objective To analyze the diagnostic value of plasma human cartilage glycoprotein 39(YKL-40),C-reactive protein(CRP),and interleukin-6(IL-6)in coronary artery injury(CAL)in children with Kawasaki disease(KD).Methods 125 children with KD admitted to the Department of Pediatrics of Lanzhou University Second Hospital from April 1,2018 to December 31,2021 were selected as the KD group.They were further divided into the CAL subgroup of 53 cases and the NCAL subgroup of 72 cases based on whether they were combined with CAL.In addition,125 healthy children who were matched in gender and age during the same period were selected as the healthy control(HC)group and 125 children with fever due to digestive tract infection as the fever control(FC)group.Collect clinical data of each group,and detect the plasma levels of YKL-40,CRP,and IL-6 in all tested children.Multivariate logistic regression analysis was used to analyze the risk factors for the occurrence of CAL in children with KD.The value of plasma YKL-40,CRP,and IL-6 in the diagnosis of CAL in children with KD was analyzed by subject performance characteristic curve(ROC).Results Comparison of plasma levels of YKL-40,CRP,and IL-6 showed that KD group>FC group>HC group(F/P=296.352/<0.001,35.162/<0.001,20.266/<0.001).The plasma levels of YKL-40,CRP,and IL-6 in the CAL subgroup were higher than those in the NCAL subgroup(t/P=7.434/<0.001,7.967/<0.001,7.444/<0.001);The proportion of pretreatment thermal duration,IVIG non response,and IVIG start time≥10 days in CAL subgroup was higher than that in NCAL subgroup(χ^(2)/P=6.831/<0.001,8.304/0.004,3.953/0.047).Multivariate logistic regression analysis showed that non response to IVIG,high YKL-40,high CRP,and high IL-6 were risk factors for developing CAL in children with KD[OR(95%CI)=4.627(2.072 to 10.336),1.441(1.128 to 1.840),1.540(1.106 to 2.145),and 1.343(1.098 to 1.644)].The ROC curve analysis showed that the area under the curve of plasma YKL-40,CRP,IL-6,and their combination in the diagnosis of CAL in children with KD w

关 键 词：川崎病 急性期冠状动脉损伤 人软骨糖蛋白-39 C反应蛋白 白介素-6 诊断 

分 类 号：R725.4[医药卫生—儿科]