PTX3及NT-proBNP在小儿川崎病冠脉损害中的意义
|
摘要
目的探讨PTX3及NT-proBNP作为生物标记物在评估儿童川崎病(KD)冠脉损害中的意义。方法检测64例KD患儿急性期及恢复期血清中PTX 3、NT-proBNP和炎症因子(IL-1β、IL-6、TNF-α)浓度,并在急性期行心脏彩超检查;同时选取同年龄仅呼吸道感染患儿和健康体检儿童各30例作为对照组进行比较和相关性评价;应用受试者工作特征曲线(ROC)分析急性期PTX3和NT-proBNP对KD的诊断效能。结果各组间血清中IL-1β、IL-6、TNF-α、NT-proBNP和PTX 3浓度的差异均有统计学意义(P<0. 01);各指标均以KD组急性期为最高。KD急性期冠状动脉损伤(CAL)组与NCAL组间比较,血清PTX3的差异有统计学意义(P<0.05)。PTX3和NT-proBNP均与IL-1β、IL-6、TNF-α成正相关(r=0.645～0.697,P<0.001)。PTX3和NT-proBNP诊断KD的ROC曲线下面积(AUC)分别为0.909(95%CI:0.862～0.957,P<0. 001)和0. 918(95%CI:0. 856～0. 981,P<0. 001)。结论 PTX 3和NT-proBNP有助于KD诊断,PTX 3与病情活动性相关,可用作病情监测。
Objective To explore the significance of PTX3 and NT-proBNP as biomarkers in evaluating the coronary artery lesion of Kawasaki disease(KD). Methods Concentrations of serum PTX3, NT-proBNP and inflammatory cytokines(IL-1β, IL-6, TNF-α) in 64 children with KD on acute and convalescent phases were detected, and color Doppler ultrasound examination was performed on the acute phase. At the same time, 30 children with only respiratory tract infection and 30 healthy children of same age were selected as control groups. Comparison and correlation evaluation were carried out for these data. Receiver operating characteristic curve was used to analyze the diagnostic efficiency of PTX3 and NT-proBNP on the acute phase for KD. Results Levels of serum PTX3, NT-proBNP and inflammatory cytokines(IL-1β, IL-6, TNF-α) on the acute phase in children with KD were higher than that on convalescent phase, and no statistical difference in two control groups was observed. PTX3 on convalescent phase was still higher than that in control groups, while there was no significant difference for other factors. The difference of serum PTX 3 between CAL and NCAL group of children with KD on the acute phase was statistically significant, meanwhile no significant difference for NT-proBNP on the two phases was found. Serum levels of PTX3 and NT-proBNP of all samples were positively correlated with that of IL-1β, IL-6 and TNF-α(γ=0.666, 0.697,0.645 and 0.674,0.675,0.694, P=0.000). Area under the receiver operating curve of PTX3 and NT-proBNP were 0.909(95% CI: 0.862-0.957,P=0.000)and 0.918(95% CI: 0.856-0.981, P=0.000), respectively. Conclusions PTX3 and NT-proBNP reflect qualitative feature and location of coronary vasculitis in KD separately. Joint combination of the both is helpful to KD early diagnosis. PTX 3 is related to the status of the the disease activity as well, thus can be used for monitoring the progress of KD.
Objective To explore the significance of PTX3 and NT-proBNP as biomarkers in evaluating the coronary artery lesion of Kawasaki disease(KD). Methods Concentrations of serum PTX3, NT-proBNP and inflammatory cytokines(IL-1β, IL-6, TNF-α) in 64 children with KD on acute and convalescent phases were detected, and color Doppler ultrasound examination was performed on the acute phase. At the same time, 30 children with only respiratory tract infection and 30 healthy children of same age were selected as control groups. Comparison and correlation evaluation were carried out for these data. Receiver operating characteristic curve was used to analyze the diagnostic efficiency of PTX3 and NT-proBNP on the acute phase for KD. Results Levels of serum PTX3, NT-proBNP and inflammatory cytokines(IL-1β, IL-6, TNF-α) on the acute phase in children with KD were higher than that on convalescent phase, and no statistical difference in two control groups was observed. PTX3 on convalescent phase was still higher than that in control groups, while there was no significant difference for other factors. The difference of serum PTX 3 between CAL and NCAL group of children with KD on the acute phase was statistically significant, meanwhile no significant difference for NT-proBNP on the two phases was found. Serum levels of PTX3 and NT-proBNP of all samples were positively correlated with that of IL-1β, IL-6 and TNF-α(γ=0.666, 0.697,0.645 and 0.674,0.675,0.694, P=0.000). Area under the receiver operating curve of PTX3 and NT-proBNP were 0.909(95% CI: 0.862-0.957,P=0.000)and 0.918(95% CI: 0.856-0.981, P=0.000), respectively. Conclusions PTX3 and NT-proBNP reflect qualitative feature and location of coronary vasculitis in KD separately. Joint combination of the both is helpful to KD early diagnosis. PTX 3 is related to the status of the the disease activity as well, thus can be used for monitoring the progress of KD.
引文
[1]Mc Crindle BW,Rowley AH,Newburger JW,et al.Diagnosis,Treatment,and Long-Term Management of Kawasaki Disease:A Scientific Statement for Health Professionals From the American Heart Association.[J].Circulation,2017,135(17):e927-e999.
[2]中华医学会儿科学分会心血管学组.川崎病冠状动脉病变的临床处理建议[J].中华儿科杂志,2012,50(10):746-749.
[3]杜忠东,陈笑征.川崎病流行病学研究进展[J].中国实用儿科杂志.2017.32(8):565-569.
[4]郭红梅,韩彦彦.川崎病病因及其发病机制研究进展[J].医学综述,2015,21(23):4260-4263.
[5]杨波,朱义杰,罗军,等.川崎病流行病学、病因和发病机制的新进展[J].临床儿科杂志,2014,32(2):189-192.
[6]马乐,杜忠东.川崎病血管内皮细胞损伤机制的研究进展[J].中华儿科杂志,2016,54(2):158-160.
[7]高放,易岂建.川崎病冠状动脉损伤机制及治疗新进展[J].国际儿科学杂志,2016,43(3):208-212.
[8]张伟洁,郑宏.IL-6介导免疫炎性反应作用及其与疾病关系的研究进展[J].细胞与分子免疫学杂志,2017,33(5):699-703.
[9]汪燕,鲁利群,贺静,等.川崎病患儿炎症因子和免疫功能指标检测的临床意义[J].儿科药学杂志,2018,24(1):4-7.
[10]林瑶,李晓惠,石琳,等.2017年版《川崎病的诊断、治疗及远期管理--美国心脏协会对医疗专业人员的科学声明》解读[J].中国实用儿科杂志,2017,32(9):641-648.
[11]王宏伟.川崎病并发心血管损害的若干问题[J].中国实用儿科杂志,2006,21(10):730-732.
[12]Harada M,Yokouchi Y,Oharaseki T,et al.Histopathological characteristics of myocarditis in acute-phase Kawasaki disease[J].Histopathology,2012,61(6):1156-1167.
[13]Hamamichi Y,Ichida F,Tsubata S,et al.Dobutamine stress radionuclide ventriculography reveals silent myocardial dysfunction in Kawasaki disease[J].Circ J,2002,66(1):63-69.
[14]柳颐龄,石坤,郭永宏,等.NT-proBNP对川崎病的诊断价值[J].重庆医学,2015,44(05):657-659.
[15]Shiraishi M,Fuse S,Mori T,et al.N-terminal pro-brain natriuretic Peptide as a useful diagnostic marker of acute Kawasaki disease in children.[J].Circ J,2013,77(8):2097-2101.
[16]Sato YZ,Molkara DP,Daniels LB,et al.Cardiovascular biomarkers in acute Kawasaki disease[J].Int J Cardiol,2013,164(1):58-63.
[17]王静,曹清,李奋,等.N末端心房脑钠肽前体在鉴别6月以下婴儿川崎病与感染性发热疾病中的应用[J].国际儿科学杂志,2017,44(8):584-586.
[18]Satoh K,Wakejima Y,Gau M,et al.Risk of coronary artery lesions in young infants with Kawasaki disease:need for a new diagnostic method[J].Int J Rheum Dis,2017,21(3):746-754.
[19]谢京,张静波.正五聚蛋白3在炎症及自身免疫中的作用[J].中国病理生理杂志,2013,29(04):752-756.
[20]Vilahur G,Badimon L.Biological actions of pentraxins[J].Vascul Pharmacol,2015,73:38-44.
[21]Zhou Y,Ni Z,Zhang J,et al.Plasma pentraxin 3 may be a better marker of peripheral artery disease in hemodialysis patients than C-reactive protein.[J].Vasc Med,2013,18(2):85-91.
[22]白春兰,张军.正五聚蛋白-3:新型心血管病炎性标志物[J].心血管病学进展,2016,37(1):87-90.
[23]Guo T,Huang L,Liu C,et al.The clinical value of inflammatory biomarkers in coronary artery disease:PTX3 as a new inflammatory marker[J].Exp Gerontol,2017,97:64-67.
[24]王凤英,黄路圣,徐康,等.正五聚蛋白3在儿童过敏性紫癜中的表达[J].中国医科大学学报,2017,46(2):156-159.
[25]易立,郭芳.正五聚素蛋白3的功能研究进展[J].中国卒中杂志,2016,11(10):894-896.
[2]中华医学会儿科学分会心血管学组.川崎病冠状动脉病变的临床处理建议[J].中华儿科杂志,2012,50(10):746-749.
[3]杜忠东,陈笑征.川崎病流行病学研究进展[J].中国实用儿科杂志.2017.32(8):565-569.
[4]郭红梅,韩彦彦.川崎病病因及其发病机制研究进展[J].医学综述,2015,21(23):4260-4263.
[5]杨波,朱义杰,罗军,等.川崎病流行病学、病因和发病机制的新进展[J].临床儿科杂志,2014,32(2):189-192.
[6]马乐,杜忠东.川崎病血管内皮细胞损伤机制的研究进展[J].中华儿科杂志,2016,54(2):158-160.
[7]高放,易岂建.川崎病冠状动脉损伤机制及治疗新进展[J].国际儿科学杂志,2016,43(3):208-212.
[8]张伟洁,郑宏.IL-6介导免疫炎性反应作用及其与疾病关系的研究进展[J].细胞与分子免疫学杂志,2017,33(5):699-703.
[9]汪燕,鲁利群,贺静,等.川崎病患儿炎症因子和免疫功能指标检测的临床意义[J].儿科药学杂志,2018,24(1):4-7.
[10]林瑶,李晓惠,石琳,等.2017年版《川崎病的诊断、治疗及远期管理--美国心脏协会对医疗专业人员的科学声明》解读[J].中国实用儿科杂志,2017,32(9):641-648.
[11]王宏伟.川崎病并发心血管损害的若干问题[J].中国实用儿科杂志,2006,21(10):730-732.
[12]Harada M,Yokouchi Y,Oharaseki T,et al.Histopathological characteristics of myocarditis in acute-phase Kawasaki disease[J].Histopathology,2012,61(6):1156-1167.
[13]Hamamichi Y,Ichida F,Tsubata S,et al.Dobutamine stress radionuclide ventriculography reveals silent myocardial dysfunction in Kawasaki disease[J].Circ J,2002,66(1):63-69.
[14]柳颐龄,石坤,郭永宏,等.NT-proBNP对川崎病的诊断价值[J].重庆医学,2015,44(05):657-659.
[15]Shiraishi M,Fuse S,Mori T,et al.N-terminal pro-brain natriuretic Peptide as a useful diagnostic marker of acute Kawasaki disease in children.[J].Circ J,2013,77(8):2097-2101.
[16]Sato YZ,Molkara DP,Daniels LB,et al.Cardiovascular biomarkers in acute Kawasaki disease[J].Int J Cardiol,2013,164(1):58-63.
[17]王静,曹清,李奋,等.N末端心房脑钠肽前体在鉴别6月以下婴儿川崎病与感染性发热疾病中的应用[J].国际儿科学杂志,2017,44(8):584-586.
[18]Satoh K,Wakejima Y,Gau M,et al.Risk of coronary artery lesions in young infants with Kawasaki disease:need for a new diagnostic method[J].Int J Rheum Dis,2017,21(3):746-754.
[19]谢京,张静波.正五聚蛋白3在炎症及自身免疫中的作用[J].中国病理生理杂志,2013,29(04):752-756.
[20]Vilahur G,Badimon L.Biological actions of pentraxins[J].Vascul Pharmacol,2015,73:38-44.
[21]Zhou Y,Ni Z,Zhang J,et al.Plasma pentraxin 3 may be a better marker of peripheral artery disease in hemodialysis patients than C-reactive protein.[J].Vasc Med,2013,18(2):85-91.
[22]白春兰,张军.正五聚蛋白-3:新型心血管病炎性标志物[J].心血管病学进展,2016,37(1):87-90.
[23]Guo T,Huang L,Liu C,et al.The clinical value of inflammatory biomarkers in coronary artery disease:PTX3 as a new inflammatory marker[J].Exp Gerontol,2017,97:64-67.
[24]王凤英,黄路圣,徐康,等.正五聚蛋白3在儿童过敏性紫癜中的表达[J].中国医科大学学报,2017,46(2):156-159.
[25]易立,郭芳.正五聚素蛋白3的功能研究进展[J].中国卒中杂志,2016,11(10):894-896.