The value of high mobility group box-1 and neutrophil elastase in the diagnosis and prediction of Kawasaki disease and coronary artery lesions
Objective To explore the clinical value of high mobility group box-1(HMGB1)and neutrophil elastase(NE)in early detection of Kawasaki disease(KD)and prediction of coronary artery lesions(CAL).Method In this case-control study,80 children with Kawasaki disease who were hospitalized in the Department of Cardiovascular Medicine,Xuzhou Children's Hospital,Xuzhou Medical University from September 2022 to October 2023 were selected as the KD group,and they were further divided into the CAL subgroup and the non-CAL(NCAL)subgroup according to the color echocardiography results of coronary artery.Additionally,40 children with fever diagnosed as respiratory infectious diseases and 40 healthy children for general health check-ups during the same period were enrolled as the fever control group and the healthy control group,respectively.The one-way ANOVA,least significant difference(LSD)method and Bonferroni correction were used to compare the serum HMGB1 and NE levels in KD group,fever control group and healthy control group as well as the changes of serum HMGB1 and NE levels in acute,sub-acute and convalescence stages of KD group.The independent sample t-test was applied to compare the differences between CAL subgroup and NCAL subgroup at acute,sub-acute and convalescence stages.The receiver operating characteristic curve was drawn to analyze the value of serum HMGB1 and NE for early detection of KD and prediction of KD with CAL.Results In the acute stage,the serum levels of HMGB1 and NE of children with KD were significantly higher than those of the two control groups,with statistically significant differences(F=60.962,45.805,all P＜0.05).The serum levels of HMGB1 and NE of the KD group were higher in the acute stage than those in the sub-acute stage and the convalescence stage,with statistically significant differences(F=14.369,26.641,all P＜0.05).The serum levels of HMGB1 and NE of the CAL subgroup were higher than those of the NCAL subgroup in the acute,sub-acute and convalescence stage,with statistically significant differences(t=-3.086,-3.055,-3.321,-5.212,-2.647,-2.345,all P＜0.05).The optimal critical values of HMGB1 and NE for early detection of KD were 2.04 pg/L and 241.00 pg/L,respectively.The area under curves(AUC)of serum HMGB1 and NE and integrated examination for early detection of KD were 0.89,0.85,and 0.90,respectively;the corresponding sensitivities were 87.50％,71.30％,and 75.00％,respectively,and the specificities were 81.20％,90.00％,and 92.50％,respectively.In the acute stage of KD group,the optimal critical values of serum HMGB1 and NE for prediction of CAL were 2.60 pg/L and 261.00 pg/L,respectively.The AUC of serum HMGB1 and NE and integrated examination for prediction of CAL were 0.70,0.80,and 0.81,respectively;the corresponding sensitivities were 63.60％,86.40％,and 72.70％,respectively,and the specificities were 70.70％,67.20％,and 77.60％,respectively.Conclusions The increased levels of serum HMGB1 and NE in KD acute stage have certain reference value for the diagnosis of KD;HMGB1 and NE have a certain role in predicting KD with CAL,and they are of greater value when they are combined for detection.
Kawasaki diseaseCoronary artery lesionsHigh mobility group box-1Neutrophil elastase
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