25-羟维生素D_3预测川崎病冠状动脉病变的价值
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摘要
目的探讨血清25-羟维生素D_3[25-(OH)D_3]对川崎病冠状动脉病变(CAL)的预测价值。方法选择2013年1月至2017年12月在海宁市中心医院就诊的川崎病患儿41例为川崎病组,同期因呼吸道感染合并发热患儿30例为对照组,同期健康体检及医护家属儿童30例为健康组,比较三组血清25-(OH)D_3水平的差异及其对CAL的预测价值。结果在41例川崎病患儿中有11例确诊为CAL,占28.83%;其中男7例,女性4例。川崎病组血清25-(OH)D_3水平为(63.43±21.05)ng/mL[CAL组为(93.04±33.61)ng/mL,非CAL组为(36.41±28.67)ng/mL],对照组为(32.54±15.73)ng/mL,健康组为(23.72±11.05)ng/mL,组间比较差异有统计学意义(F=5.905,P=0.002),其中CAL组高于非CAL组、对照组和健康组(t值分别为4.056、5.006、9.317,均P<0.05)。Logistic回归分析表明年龄、使用甲基强的松是CAL的保护因素,而中性粒细胞、C反应蛋白(CRP)和25-(OH)D_3升高是CAL的独立危险因素;ROC曲线下面积(AUC)为0.827(95%CI:0.677～0.927)(Z=4.919,P<0.001),诊断折点为64ng/mL,对应敏感度为88.21%,特异度为83.67%,Youden指数为0.576。结论川崎病急性期血清25-(OH)D_3水平对CAL的形成有重要的预测意义,但无法区分川崎病和健康儿童。
Objective To evaluate the predictive value of serum 25 hydroxyvitamin D_3 [25-(OH) D_3] in coronary arterial lesions(CAL) of Kawasaki disease. Methods From January 2013 to December 2017, 41 children with Kawasaki disease in Haining Central Hospital were selected in Kawasaki disease group. Thirty children with respiratory infection and fever were selected in control group and 30 healthy children were selected in healthy group. The difference in serum 25-(OH) D_3 level and the predictive value for CAL were compared among three groups. Results Eleven cases(28.83%) were diagnosed as CAL in 41 children with Kawasaki disease, including 7 males and 4 females. The serum 25-(OH) D_3 level of the Kawasaki disease group was 63.43±21.05 ng/mL(CAL group: 93.04±33.61 ng/mL, non CAL group: 36.41±28.67 ng/mL), that of the control group was 32.54±15.73 ng/mL and of the healthy group was 23.72±11.05 ng/mL. There was statistical difference among groups(F=5.905,P=0.002). CAL group was higher than non CAL group, control group and healthy group(t value was 4.056, 5.006 and 9.317, respectively, all P<0.05). Logistic regression analysis showed that age and methylprednisone usage were protective factors for CAL, while neutrophils, CRP and 25-(OH)D_3 increasing were independent risk factors for CAL. The area under ROC curve(AUC) was 0.827(95%CI: 0.677-0.927)(Z=4.919,P<0.001). Diagnostic break point was 64 ng/mL, sensitivity was 88.21%, specificity was 83.67%, and the Youden index was 0.576. Conclusion The level of serum 25-(OH)D_3 in acute phase of Kawasaki disease has important predictive value for CAL, but it cannot distinguish children with Kawasaki disease from healthy children.
Objective To evaluate the predictive value of serum 25 hydroxyvitamin D_3 [25-(OH) D_3] in coronary arterial lesions(CAL) of Kawasaki disease. Methods From January 2013 to December 2017, 41 children with Kawasaki disease in Haining Central Hospital were selected in Kawasaki disease group. Thirty children with respiratory infection and fever were selected in control group and 30 healthy children were selected in healthy group. The difference in serum 25-(OH) D_3 level and the predictive value for CAL were compared among three groups. Results Eleven cases(28.83%) were diagnosed as CAL in 41 children with Kawasaki disease, including 7 males and 4 females. The serum 25-(OH) D_3 level of the Kawasaki disease group was 63.43±21.05 ng/mL(CAL group: 93.04±33.61 ng/mL, non CAL group: 36.41±28.67 ng/mL), that of the control group was 32.54±15.73 ng/mL and of the healthy group was 23.72±11.05 ng/mL. There was statistical difference among groups(F=5.905,P=0.002). CAL group was higher than non CAL group, control group and healthy group(t value was 4.056, 5.006 and 9.317, respectively, all P<0.05). Logistic regression analysis showed that age and methylprednisone usage were protective factors for CAL, while neutrophils, CRP and 25-(OH)D_3 increasing were independent risk factors for CAL. The area under ROC curve(AUC) was 0.827(95%CI: 0.677-0.927)(Z=4.919,P<0.001). Diagnostic break point was 64 ng/mL, sensitivity was 88.21%, specificity was 83.67%, and the Youden index was 0.576. Conclusion The level of serum 25-(OH)D_3 in acute phase of Kawasaki disease has important predictive value for CAL, but it cannot distinguish children with Kawasaki disease from healthy children.
引文
[1]张颖,犹登霞,周杰林.典型川崎病与不完全川崎病的临床特征分析[J].中国妇幼健康研究,2018,29(11):1475-1479.
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[6]Mikasa K,Aoki N,Aoki Y,et al.JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases:The Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy - The JAID/JSC Guide to Clinical Management of Infectious Disease/Guideline-preparing Committee Respiratory Infectious Disease WG[J].J Infect Chemother,2016,22(7Suppl):S1-S65.
[7]Yang T J,Lin M T,Lu C Y,et al.The prevention of coronary arterial abnormalities in Kawasaki disease:a meta-analysis of the corticosteroid effectiveness[J].J Microbiol Immunol Infect,2018,51(3):321-331.
[8]Cho K H,Kang S J.Clinically useful predictors of resistance to intravenous immunoglobulin and prognosis of coronary artery lesions in patients with incomplete kawasaki disease[J].Korean Circ J,2014,44(5):328-335.
[9]Noval Rivas M,Lee Y,Wakita D,et al.CD8+ T cells contribute to the development of coronary arteritis in the lactobacillus casei cell wall extract-induced murine model of Kawasaki Disease[J].Arthritis Rheumatol,2017,69(2):410-421.
[10]Kuo H C,Wang C L,Yang K D,et al.Plasma prostaglandin E2 levels correlated with the prevention of intravenous immunoglobulin resistance and coronary artery lesions formation via CD40L in Kawasaki Disease[J].PLoS One,2016,11(8):e0161265.
[11]Jun J S,Jung Y K,Lee D W.Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease[J].Korean J Pediatr,2017,60(7):216-220.
[12]Xu W R,Jin H F,Du J B.Vitamin D and cardiovascular risk in children[J].Chin Med J (Engl),2017,130(23):2857-2862.
[13]Stagi S,Rigante D,Lepri G,et al.Severe vitamin D deficiency in patients with Kawasaki disease:a potential role in the risk to develop heart vascular abnormalities?[J].Clin Rheumatol,2016,35(7):1865-1872.
[14]Lim L M,Zhao X,Chao M C,et al.Novel Vitamin D receptor mutations in hereditary vitamin d resistant rickets in Chinese[J].PLoS One,2015,10(9):e0138152.
[15]Mao S,Huang S.Vitamin D receptor gene polymorphisms and the risk of rickets among Asians:a meta-analysis[J].Arch Dis Child,2014,99(3):232-238.
[2]Lin M T,Wu M H.The global epidemiology of Kawasaki disease:review and future perspectives[J].Glob Cardiol Sci Pract,2017,2017(3):e201720.
[3]Okuma Y,Suda K,Nakaoka H,et al.Serum Tenascin-C as a novel predictor for risk of coronary artery lesion and resistance to intravenous immunoglobulin in Kawasaki Disease-a multicenter retrospective study[J].Circ J,2016,80(11):2376-2381.
[4]Miki K,Fujii K,Kawasaki D,et al.Impact of analysis interval size on the quality of optical frequency domain imaging assessments of stent implantation for lesions of the superficial femoral artery[J].Catheter Cardiovasc Interv,2017,89(4):735-745.
[5]Chen Y L,Wang J L,Li W Q.Prediction of the risk of coronary arterial lesions in Kawasaki disease by serum 25-hydroxyvitamin D3[J].Eur J Pediatr,2014,173(11):1467-1471.
[6]Mikasa K,Aoki N,Aoki Y,et al.JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases:The Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy - The JAID/JSC Guide to Clinical Management of Infectious Disease/Guideline-preparing Committee Respiratory Infectious Disease WG[J].J Infect Chemother,2016,22(7Suppl):S1-S65.
[7]Yang T J,Lin M T,Lu C Y,et al.The prevention of coronary arterial abnormalities in Kawasaki disease:a meta-analysis of the corticosteroid effectiveness[J].J Microbiol Immunol Infect,2018,51(3):321-331.
[8]Cho K H,Kang S J.Clinically useful predictors of resistance to intravenous immunoglobulin and prognosis of coronary artery lesions in patients with incomplete kawasaki disease[J].Korean Circ J,2014,44(5):328-335.
[9]Noval Rivas M,Lee Y,Wakita D,et al.CD8+ T cells contribute to the development of coronary arteritis in the lactobacillus casei cell wall extract-induced murine model of Kawasaki Disease[J].Arthritis Rheumatol,2017,69(2):410-421.
[10]Kuo H C,Wang C L,Yang K D,et al.Plasma prostaglandin E2 levels correlated with the prevention of intravenous immunoglobulin resistance and coronary artery lesions formation via CD40L in Kawasaki Disease[J].PLoS One,2016,11(8):e0161265.
[11]Jun J S,Jung Y K,Lee D W.Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease[J].Korean J Pediatr,2017,60(7):216-220.
[12]Xu W R,Jin H F,Du J B.Vitamin D and cardiovascular risk in children[J].Chin Med J (Engl),2017,130(23):2857-2862.
[13]Stagi S,Rigante D,Lepri G,et al.Severe vitamin D deficiency in patients with Kawasaki disease:a potential role in the risk to develop heart vascular abnormalities?[J].Clin Rheumatol,2016,35(7):1865-1872.
[14]Lim L M,Zhao X,Chao M C,et al.Novel Vitamin D receptor mutations in hereditary vitamin d resistant rickets in Chinese[J].PLoS One,2015,10(9):e0138152.
[15]Mao S,Huang S.Vitamin D receptor gene polymorphisms and the risk of rickets among Asians:a meta-analysis[J].Arch Dis Child,2014,99(3):232-238.