肝素结合蛋白与白蛋白比值评估川崎病休克综合征病情的价值  

The value of the ratio of heparin binding protein to albumin in evaluating the state of shock syndrome in Kawasaki disease

作　　者：康霞艳 张新萍[1] 范江花[2] 罗海燕[2] 袁远宏[1] 肖政辉[1] Kang Xiayan;Zhang Xinping;Fan Jianghua;Luo Haiyan;Yuan Yuanhong;Xiao Zhenghui(Department of Pediatric Intensive Care Unit,Hunan Children’s Hospital,Changsha 410007,China;Department of Pediatric Emergency Center,Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院重症医学科,长沙410007 [2]湖南省儿童医院疑难综合科,长沙410007

出　　处：《中华急诊医学杂志》2024年第3期365-370,共6页Chinese Journal of Emergency Medicine

基　　金：湖南省临床医疗技术创新引导项目(2021SK50528)。

摘　　要：目的探讨肝素结合蛋白(heparin binding protein,HBP)与白蛋白(albumin,ALB)比值在川崎病休克综合征的诊断及疾病严重程度的预测价值。方法本研究为回顾性研究,选取2019年1月至2022年5月入住湖南省儿童医院儿童重症监护室、疑难综合科并确诊为川崎病(Kawasaki disease,KD)的患儿为研究对象。根据HBP、ALB计算HBP/ALB比值,按HBP/ALB比值两者的中位数及上下位四分位数将研究对象分为三组(低、中、高比值组),比较三组间各指标的差异,应用受试者工作特征曲线分析探讨HBP/ALB比值对川崎病休克综合征(Kawasaki disease shock syndrome,KDSS)的诊断及疾病严重程度的临床价值。结果本研究共纳入病例111例,其中低比值组28例,中比值组56例,高比值组27例,出现冠脉受损24例,无冠脉受损87例,心电图表现异常27例,17例患儿出现KDSS(中比值组5例,高比值组12例)。三组比较中,高比值组患儿KDSS的发生率、冠脉受累、心电图异常的比例较高,肌钙蛋白、N末端脑尿肽、乳酸、每搏输出变异、胸腔液体水平、白细胞、C反应蛋白、降钙素原、D-二聚体值更高,而ALB及血钠值较低,差异均有统计学意义(均P<0.05),而低比值组、中比值组间比较差异无统计学意义(均P>0.05)。HBP/ALB在预测KDSS方面,HBP/ALB比值的曲线下面积、敏感度和特异度(分别为0.942、0.882、0.883)均高于HBP单项指标(分别为0.776、0.842、0.670)。结论HBP/ALB比值可反映KD患儿的严重程度,且对预后评估具有一定的临床价值。Objective To investigate the value of the ratio of heparin binding protein(HBP)to albumin(ALB)in diagnosis and predict the severity of Kawasaki disease shock syndrome(KDSS).Methods This study was a retrospective study.Pediatric patients with Kawasaki disease(KD)admitted to the Children's Intensive Care Unit and department of Pediatric Emergency Center of Hunan Children's Hospital from January 2019 to May 2022 were enrolled.The HBP/ALB ratio was calculated according to HBP and serum ALB.The children were divided into three groups(low,medium,and high ratio groups)according to the median and upper and lower quartiles of the HBP/ALB ratio.The differences of each index among the three groups were compared.The receiver operating characteristic curves were drawn to evaluate the clinical value of the HBP/ALB ratio in diagnosis of KDSS and the severity of the disease.Results A total of 111 cases were included in this study,including 28 cases in the low ratio group,56 cases in the medium ratio group,and 27 cases in the high ratio group.There were 24 cases with coronary artery damage,87 cases without coronary artery damage,27 cases with abnormal ECG findings,and 17 children with KDSS(including 5 cases in the medium ratio group,and 12 cases in the high ratio group).The incidence of KDSS,coronary involvement,and abnormal electrocardiogram proportions in the high ratio group were significantly higher than those in the other two groups.Compared with low and medium ratio groups,the levels of cardiac troponin I,N-terminal pro-brain natriuretic peptide,lactate,stroke output variation,trends in thoracic fluid content,white blood cell count,C-reactive protein,procalcitonin,and D-dimer levels were higher in the high ratio group,while ALB and blood sodium levels were lower in the high ratio group(all P<0.05).There was no significant difference in above indicators between the low and medium ratio groups(all P>0.05).The HBP/ALB ratio had a higher area under the curve,sensitivity,and specificity(0.942,0.882,and 0.883,respectively)in pred

关 键 词：肝素结合蛋白 川崎病 川崎病休克综合征 儿童 

分 类 号：R725.4[医药卫生—儿科]