摘要
目的 探究超声参数及血液相关指标的变化用于预测川崎病患儿发生冠状动脉病变的临床价值.方法 采用病例对照研究方案,选取2021年1月至2023年12月在安徽省儿童医院确诊的145例川崎病患儿,根据患儿冠状动脉是否发生病变分为冠状动脉病变组(n=65)和无冠状动脉病变组(n=80).比较两组患儿左冠状动脉主干、左前降支、右冠状动脉测定Z值、左室射血分数(LVEF);同时比较两组患儿及冠状动脉病变组患儿不同病变程度血液红细胞体积分布宽度(RDW)、C反应蛋白(CRP)、氨基末端脑利钠肽前体(NT-proBNP)水平;通过受试者操作特征(ROC)曲线分析超声参数及血清RDW、CRP和NT-proBNP水平预测川崎病患儿发生冠状动脉病变的价值.结果 冠状动脉病变组患儿的左冠状动脉主干、左前降支、右冠状动脉测定Z值分别为3.05±0.45、3.42±0.52、2.78±0.38,均高于无冠状动脉病变组患儿(1.73±0.25、1.70±0.27、1.68±0.23),LVEF为(66.26±3.11)％,低于无冠状动 脉病变组患儿[(68.38±4.14)％],差异均有统计学意义(P＜0.05).冠状动脉病变组患儿的血液RDW、CRP和NT-proBNP水平分别为(13.95±0.74)％、(79.24±12.89)mg/L、(481.56±94.15)pg/mL,均高于无冠状动脉病变组患儿[(12.83±0.65)％、(56.87±11.46)mg/L、(367.19±77.91)pg/mL],差异均有统计学意义(P＜0.05);且冠状动脉瘤患儿血清 RDW、CRP 和 NT-proBNP 水平分别为(14.35±0.66)％、(69.45±10.59)mg/L、(492.86±95.67)pg/mL,均明显高于冠状动脉轻度扩张患儿[(13.56±0.67)％、(53.35±8.15)mg/L、(389.25±70.16)pg/mL],差异均有统计学意义(P＜0.05).ROC曲线结果显示,左冠状动脉主干、左前降支、右冠状动脉测定Z值及血清RDW、CRP和NT-proBNP水平用于预测川崎病并发冠状动脉病变的曲线下面积(AUC)值均大于0.7,LVEF的AUC值为0.356,且联合预测AUC值均高于单一检测.结论 川崎病并发冠状动脉病变后超声参数及血液RDW、CRP和NT-proBNP水平明显改变,联合检测相关指标用于诊断川崎病患儿发生冠状动脉病变具有较高的临床价值,且血液RDW、CRP和NT-proBNP水平检测可作为诊断川崎病患儿发生冠状动脉病变严重程度的参考.
Abstract
Objective To investigate the clinical value of ultrasound parameters and blood-related indexes in predicting the occurrence of coronary artery lesions in children with Kawasaki disease.Methods A case-control study program was used to select 145 children with Ka-wasaki disease diagnosed in Anhui Province Children's Hospital from January 2021 to December 2023,and the children were divided into the coro-nary artery disease group(n=65)and non-coronary artery disease group(n=80)according to the presence or absence of coronary artery dis-ease.The Z value of the left main coronary artery,left anterior descending branch and right coronary artery and left ventricular ejection fraction(LVEF)of the children of both groups were measured,and the serum blood parameters of the children with different degrees of lesions in both groups and the Kawasaki disease coronary dilatation group were compared.The serum red cell volume distribution width(RDW),C-reaction protein(CRP),n-terminal pro-brain natriuretic peptide(NT-proBNP)levels of the children in the two groups and the children with different degrees of lesions in the coronary artery disease group were compared,and the value of ultrasound parameters and serum RDW,CRP and NT-proBNP levels in predicting coronary artery disease in children with Kawasaki disease was analyzed by receiver operating characteristic(ROC)curve.Results The Z values of left main coronary artery,left anterior descending artery and right coronary artery in the coronary artery disease group were 3.05±0.45,3.42±0.52 and 2.78±0.38,respectively,which were higher than those in the non-coronary artery disease group(1.73±0.25,1.70±0.27,1.68±0.23),the LVEF was(66.26±3.11)％,which was lower than that in the non-coronary artery disease group[(68.38±4.14)％],and the differences were statistically significant(P＜0.05).The levels of RDW,CRP and NT-proBNP in the coronary artery disease group were(13.95±0.74)％,(79.24±12.89)mg/L and(481.56±94.15)pg/mL,respectively,which were higher than those in the non-coronary artery disease group[(12.83±0.65)％,(56.87±11.46)mg/L,(367.19±77.91)pg/mL],and the differ-ences were statistically significant(P＜0.05);and the levels of RDW,CRP and NT-proBNP in children with coronary artery aneurysm were(14.35±0.66)％,(69.45±10.59)mg/L and(492.86±95.67)pg/mL,respectively,which were significantly higher than those in children with mild coronary artery dilatation[(13.56±0.67)％,(53.35±8.15)mg/L,(389.25±70.16)pg/mL],the differences were statistically significant(P＜0.05).The ROC curves found that the area under the curve(AUC)values of the left coronary artery trunk,left anterior de-scending branch,and right coronary artery measured Z value,and the levels of RDW,CRP,and NT-proBNP used for predicting the complication of Kawasaki disease with coronary artery disease were greater than 0.7,and the AUC value of the left ventricular ejection fraction was 0.356,and the combined prediction AUC value was higher than that of the single test.Conclusion The ultrasound parameters and serum RDW,CRP and NT-proBNP levels were significantly changed after Kawasaki disease complicating coronary artery disease,and the combined detection of related in-dexes for diagnosing coronary artery disease in children with Kawasaki disease has high clinical value,and the detection of serum RDW,CRP and NT-proBNP levels can be used as a diagnostic tool for diagnosing the severity of coronary artery disease in children with Kawasaki disease.The serum RDW,CRP and NT-proBNP levels can be used to diagnose the severity of coronary lesions in children with Kawasaki disease.
基金项目
安徽省卫生健康委员会科研项目(2019SEY001)
NETL
NSTL
万方数据