川崎病患儿血清NT⁃proBNP、心肌损伤标志物及心功能水平与并发冠状动脉病变的关系  

The relationship between serum NT⁃proBNP,myocardial injury markers,and cardiac function levels in children with Kawasaki disease and concurrent coronary artery disease

作　　者：焦丽华 洪源[1] 刘建丽[1] 王建伟 冯千伟 王红芳[1] 王晓青[1] 刘寅[1] Jiao Lihua;Hong Yuan;Liu Jianli;Wang Jianwei;Feng Qianwei;Wang Hongfang;Wang Xiaoqing;Liu Yin(Department of Pediatrics,Tangshan Maternal and Child Health Hospital,Hebei Province,Tangshan 063000,China)

机构地区：[1]河北省唐山市妇幼保健院儿内科,063000

出　　处：《疑难病杂志》2023年第6期578-582,588,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究课题计划项目(20221771)。

摘　　要：目的分析川崎病(KD)患儿血清N末端脑钠肽前体(NT⁃proBNP)、心肌损伤标志物及心功能参数水平与并发冠状动脉病变的关系。方法选取2019年9月—2022年4月唐山市妇幼保健院儿内科收治KD患儿112例作为观察组,根据超声心电图诊断结果分为冠状动脉异常亚组(CAA亚组,47例)和非冠状动脉异常亚组(NCAA亚组,65例)。另选取体检健康儿童102例作为健康对照组。采用化学发光免疫法检测血清NT⁃proBNP水平,酶联免疫吸附法测定血清心肌肌钙蛋白I(cTnI)、肌红蛋白(Mb)、肌酸激酶同工酶MB(CK⁃MB)水平;测量左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、心脏指数(CI)、舒张期二尖瓣血流频谱速度(E/A);Logistic回归分析KD患儿发生冠状动脉病变的影响因素;受试者工作特征曲线(ROC)分析血清NT⁃proBNP、cTnI、Mb、CK⁃MB对KD患儿发生冠状动脉病变的预测效能。结果观察组急性期血清NT⁃proBNP、cTnI、Mb、CK⁃MB水平高于恢复期和健康对照组(F=725.260、651.547、573.800、292.951,P均<0.001)。CAA亚组血清NT⁃proBNP、cTnI、Mb、CK⁃MB水平高于NCAA亚组(t=4.495、13.120、11.234、12.609,P均<0.001)。观察组急性期LVEF、LVFS、CI的水平显著低于恢复期(t=3.885、6.081、5.019,P均<0.001)。血清NT⁃proBNP高、cTnI高、Mb高、CK⁃MB高水平及LVEF低、LVFS低、CI低均是KD患儿发生冠状动脉病变的危险因素[OR(95%CI)=1.440(1.069~1.940)、1.366(1.090~1.712)、1.514(1.171~1.958)、1.412(1.110~1.797)、1.534(1.203~1.956)、1.666(1.074~2.583)、1.386(1.083~1.775)]。血清NT⁃proBNP、cTnI、Mb、CK⁃MB及四者联合预测KD患儿发生冠状动脉病变的曲线下面积(AUC)分别为0.742、0.948、0.949、0.923、0.973(Z/P=4.980/0.000,1.024/0.306,0.920/0.357,1.553/0.121)。结论KD患儿血清NT⁃proBNP、cTnI、Mb、CK⁃MB表达水平升高及LVEF、LVFS、CI降低,均是KD患儿并发冠状动脉病变的危险因素,血清NT⁃proBNP、cTnI、Mb、CK⁃MB水平�Objective To explore the relationship between the levels of serum N⁃terminal proBNP(NT⁃proBNP),myocardial injury markers,and cardiac function parameters in children with Kawasaki disease(KD)and concurrent coronary artery disease.Methods One hundred and twelve pediatric patients with KD admitted to the Department of Pediatrics at Tangshan Maternal and Child Health Hospital from September 2019 to April 2022 were selected as the observation group.Based on the ultrasound electrocardiogram diagnosis results,they were divided into coronary artery abnormality subgroup(CAA subgroup,47 cases)and non coronary artery abnormality subgroup(NCAA subgroup,65 cases).102 healthy children undergoing physical examination were selected as the healthy control group.Serum NT⁃proBNP levels were measured using chemiluminescence immunoassay,and serum cardiac troponin I(cTnI),myoglobin(Mb),and creatine kinase isoenzyme MB(CK⁃MB)levels were measured using enzyme⁃linked immunosorbent assay;Left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(LVFS),cardiac index(CI),and diastole mitral flow spectral velocity(E/A)were measured.Logistic regression analysis of the influencing factors of coronary artery disease in children with KD;The predictive efficacy of serum NT⁃proBNP,cTnI,Mb,and CK⁃MB in predicting coronary artery disease in children with KD was analyzed using the receiver operating characteristic curve(ROC)analysis.Results The serum levels of NT⁃proBNP,cTnI,Mb,and CK⁃MB in the acute phase of the observation group were higher than those in the recovery phase and the healthy control group(F=725.260,651.547,573.800,292.951,P<0.001).The serum levels of NT⁃proBNP,cTnI,Mb,and CK⁃MB in the CAA subgroup were higher than those in the NCAA subgroup(t=4.495,13.120,11.234,12.609,P<0.001).The levels of LVEF,LVFS,and CI in the acute phase of the observation group were significantly lower than those in the recovery phase(t=3.885,6.081,5.019,P<0.001).High serum NT⁃proBNP,high cTnI,high Mb,high CK⁃

关 键 词：川崎病 冠状动脉病变 N末端脑钠肽前体 心肌损伤标志物 心功能水平 

分 类 号：R543.3[医药卫生—心血管疾病] R725.4[医药卫生—内科学]