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目的观察血浆中N末端脑钠肽前体(NT-pro BNP)水平在不完全川崎病(IKD)急性期的变化,探讨其在IKD中的诊断意义,并进一步研究NT-pro BNP对早期预测川崎病静脉注射丙种球蛋白(IVIG)无反应的作用。方法选取2013年7月至2014年12月在华中科技大学同济医学院附属同济医院儿科住院治疗的川崎病患儿239例,其中典型川崎病(TKD)110例,IKD129例,分别于急性期采取血样本,检测血浆中NT-pro BNP水平,同时检测血白细胞计数、中性粒细胞比例、血小板计数、C反应蛋白(CRP)、红细胞沉降率(ESR)、丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)以及白蛋白水平,并选取同期65例呼吸道感染患儿作为对照组,运用方差分析比较3组之间的差异。同时运用ROC曲线分析评价NT-pro BNP对川崎病的诊断意义,并与其他差异具有统计学意义的检测项目进行对比。所有川崎病患儿入院后均给予IVIG 2 g/kg及口服阿司匹林治疗,运用t检验比较IVIG无反应组与敏感组之间血浆NT-pro BNP水平的差异。结果 IKD患儿急性期NT-pro BNP水平为(796.24±1324.26)ng/L,明显高于对照组[(168.85±208.24)ng/L,P<0.05],与TKD患儿NT-pro BNP水平[(1362.70±2576.49)ng/L]比较,差异无统计学意义。NT-pro BNP诊断川崎病ROC曲线下面积(AUC)为0.786,取临界值191.5 ng/L时,灵敏度和特异度分别为70.0%和76.9%,与白蛋白、血白细胞计数、CRP以及ESR结果相近。IVIG无反应组和敏感组NT-pro BNP水平分别为(1215.15±1663.33)ng/L和(1043.66±2056.45)ng/L,两组比较差异无统计学意义(P=0.700)。结论血浆中NT-pro BNP在IKD急性期显著增高,可作为早期诊断IKD的参考指标之一,但对早期预测川崎病IVIG无反应无明显作用。
Objective To observe the changes of plasma NT-proBNP level in acute Kawasaki disease (IKD) and to investigate the significance of NT-pro BNP in early diagnosis of IKD Kawasaki disease intravenous gamma globulin (IVIG) non-responsive role. Methods Totally 239 children with Kawasaki disease were admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from July 2013 to December 2014. Among them, there were 110 cases of typical Kawasaki disease (TKD) and 129 cases of IKD, which were taken in acute phase The level of NT-pro BNP in blood samples was measured and the blood leukocyte count, neutrophil ratio, platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine aminotransferase Aspartate aminotransferase (AST) and albumin levels, and select the same period in 65 cases of children with respiratory tract infection as a control group, using ANOVA to compare the differences between the three groups. At the same time, the diagnostic significance of NT-pro BNP on Kawasaki disease was evaluated by ROC curve analysis and compared with other test items with statistical significance. All children with Kawasaki disease were given IVIG 2 g / kg and oral aspirin after admission, and the t-test was used to compare the difference of plasma NT-pro BNP level between IVIG non-responsive group and sensitive group. Results The level of NT-pro BNP in acute IKD children was (796.24 ± 1324.26) ng / L, which was significantly higher than that in the control group [(168.85 ± 208.24) ng / L, P <0.05] [(1362.70 ± 2576.49) ng / L], the difference was not statistically significant. The area under the curve of AUC of NT-pro BNP in diagnosis of Kawasaki disease was 0.786, and the sensitivity and specificity were 70.0% and 76.9% respectively when the critical value was 191.5 ng / L, which was correlated with albumin, white blood cell count, CRP and ESR results similar. The levels of NT-pro BNP in non-responder group and sensitive group were (1215.15 ± 1663.33) ng / L and (1043.66 ± 2056.45) ng / L, respectively. There was no significant difference between the two groups (P = 0.700). Conclusion Plasma NT-pro BNP is significantly increased in the acute phase of IKD, which may be used as a reference index for the early diagnosis of IKD. However, it has no effect on the early prediction of Kawasaki disease IVIG.