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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

22卷

期数:

2016年06期

页码:

502-504

栏目:

临床医学

出版日期:

2016-11-20

文章信息/Info

Title:

Predictive value of plasma brain natriuretic peptide in IVIG-resistant Kawasaki disease

文章编号:

1006-8147（2016）06-0502-3

作者:

王晓晓; 周宇辉; 王 倩; 郑荣秀

(天津医科大学总医院儿科,天津 300052)

Author(s):

WANG Xiao-xiao ;  ZHOU Yu-hui ;  WANG Qian ;  ZHENG Rong-xiu

(Department of Pediatrics , General Hospital,Tianjin Medical University,Tianjin 300052,China)

关键词:

川崎病; 静脉丙种球蛋白; 氨基末端脑钠肽前体; 预测; 儿童

Keywords:

Kawasaki disease ; IVIG; brain natriuretic peptide ;  predictive value ;  children

分类号:

R725

DOI:

-

文献标志码:

A

摘要:

目的：探讨氨基末端脑钠肽前体(NT-proBNP)对静脉输注丙种球蛋白（IVIG）无反应性川崎病(KD)的预测价值。方法：回顾分析临床资料完整的KD患儿102例。根据患儿对IVIG治疗的敏感性，分为IVIG敏感组及IVIG无反应组。对患儿的临床特征及实验室检查等资料进行比较，并行ROC曲线分析。结果：102例KD患儿中，有88例（86.2％）对丙种球蛋白敏感，14例（13.7％）无反应。IVIG敏感组血浆NT-proBNP水平为(830.91±748.08) ng／L，无反应组为(1820.67±1 454.13) ng／L，无反应组血浆NT-proBNP水平明显高于敏感组（P为0.010），差异有统计学意义。IVIG无反应组患儿WBC、CRP水平显著高于IVIG敏感组（P分别为0.019，＜0.001），而前者血清钠（Na⁺）、肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）水平明显低于后者（P分别为0.001，0.021，0.030），差异有统计学意义。线性相关性分析显示，KD患儿血浆NT-proBNP浓度与CRP存在明显正相关（r=0.37，P=0.02），与Na⁺成负相关(r=-0.33，P=0.01)。血浆NT-proBNP浓度与WBC、血小板、血沉间未见相关性。当血浆NT-proBNP浓度为746.3 ng/L时，预测KD患儿对丙种球蛋白是否敏感的灵敏度为0.917，特异度为0.674。结论：血浆NT-proBNP水平升高可作为预测KD患儿对丙种球蛋白是否敏感特异性指标，特别是当血浆NT-proBNP浓度高于746.3 ng /L时，KD患儿发生丙种球蛋白无反应的可能性大。

Abstract:

Objective: To discuss the predictive value of plasma brain natriuretic peptide (BNP)in IVIG-resistant Kawasaki disease (KD). Methods: Medical records of 102 children diagnosed with KD were reviewed .Sub-jects were then divided into two groups: IVIG-responsive and IVIG-resistant. The clinical features and laboratory data were obtained and analyzed by ROC. Results: Of 102 patients ,14(13.7%) children with KD were not responsive to initial intravenous immu-noglobulin (IVIG) treatment. For the two groups of KD patients, the levels of plasma BNP,WBC and CRP in IVIG-resistant group were higher than the IVIG-responsive group. There were a significant positive linear correlation between BNP and CRP (r=0.37，P=0.02)and a negative linear correlation between BNP and Na⁺ (r=-0.33，P=0.01). When the level of plasma BNP was 746.3 ng/L, the predictive sensitivity in patients with KD was 0.917, and the specificity was 0.674. Conclusion: The increase of plasma BNP level can be used to predict whether children with KD are responsive to initial intravenous immu-noglobulin (IVIG) treatment, especially when the level of plasma BNP is higher than 746.3 ng /L.

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备注/Memo

备注/Memo:

作者简介 王晓晓（1990-），女，硕士在读，研究方向：小儿内分泌代谢性疾病；通信作者：郑荣秀， E-mail: rxzheng@hotmail.com。

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更新日期/Last Update: 2016-11-25