N端脑钠肽前体与TNF-α在IKD早期诊断中的价值
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摘要
目的检测不完全川崎病(IKD)患儿急性期外周血N端脑钠肽前体(NT-proBNP)与肿瘤坏死因子α(TNF-α)的表达水平,探讨其在IKD早期诊断中的价值。方法选择川崎病(KD)患儿48例,其中典型川崎病(KD组)28例,不完全川崎病(IKD组)20例,分别于急性期空腹采取外周静脉血,检测血清NT-proBNP与TNF-α浓度,同时检测C反应蛋白(CRP)、血沉(ESR)、血白细胞计数(WBC)、丙氨酸氨基转移酶(ALT)。另选取同期治疗的呼吸道感染的发热患儿30例作为对照组。分析比较两组川崎病患儿临床特征及各组间实验室指标的差异。结果 IKD组患儿皮疹、结膜充血、颈部淋巴结肿大发生率均较KD组低,差异有统计学意义(P均<0.01);IKD组草莓舌、肢端改变发生率与KD组比较,差异无统计学意义(P均>0.05)。IKD组、KD组患儿血NT-proBNp、TNF-α、CRP、ESR、WBC、ALT水平较对照组显著升高,差异有统计学意义(P均<0.05)。IKD组患儿血NT-proBNP、TNF-α、CRP、ESR、WBC、ALT水平与KD组比较,差异无统计学意义(P均>0.05)。结论 NT-proBNP与TNF-α在不完全川崎病急性期有较高的表达水平,联合测定外周血NT-proBNP、TNF-α浓度或可作为早期辅助诊断IKD的实验室参考指标。
Objective To observe the expression levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and tumor necrosis factor alpha(TNF-α)in acute peripheral blood of children with incomplete Kawasaki disease(IKD),and explore its value in the early diagnosis of incomplete Kawasaki disease. Methods 48 children with Kawasaki disease were selected,including 28 cases of typical Kawasaki disease(group KD)and 20 cases of incomplete Kawasaki disease(group IKD).Peripheral venous blood was taken from the acute phase of the empty abdomen to detect the serum concentration of NTproBNP and TNF-α,and the C reactive protein(CRP),erythrocyte sedimentation rate(ESR),blood leukocyte count(WBC)and alanine aminotransferase(ALT)were detected. Another 30 children with fever of respiratory tract infection treated in our department during the same period were selected as control group. The clinical characteristics of children with Kawasaki disease in the two groups and the differences in laboratory indicators among the groups were analyzed and compared. Results The incidence of rash,conjunctival congestion and cervical lymph node enlargement in the IKD group was lower than those in the KD group(P<0.01),and there was no significant difference in the incidence of changes of strawberry tongue and limb in the IKD group compared with the KD group(P>0.05). The blood NT-proBNP,TNF-α,CRP,ESR,WBC and ALT levels in group IKD and group KD were significantly higher than those in the control group(P<0.01). There was no significant difference in blood NT-proBNP,TNF-α,CRP,ESR,WBC and ALT between group IKD and KD group(P>0.05). Conclusion The levels of expression of NT-proBNP and TNF-α were high in the acute stage of incomplete Kawasaki disease. The combined determination of NT-proBNP and TNF-α concentrations in peripheral blood might be used as a laboratory reference for early diagnosis of incomplete Kawasaki disease.
Objective To observe the expression levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and tumor necrosis factor alpha(TNF-α)in acute peripheral blood of children with incomplete Kawasaki disease(IKD),and explore its value in the early diagnosis of incomplete Kawasaki disease. Methods 48 children with Kawasaki disease were selected,including 28 cases of typical Kawasaki disease(group KD)and 20 cases of incomplete Kawasaki disease(group IKD).Peripheral venous blood was taken from the acute phase of the empty abdomen to detect the serum concentration of NTproBNP and TNF-α,and the C reactive protein(CRP),erythrocyte sedimentation rate(ESR),blood leukocyte count(WBC)and alanine aminotransferase(ALT)were detected. Another 30 children with fever of respiratory tract infection treated in our department during the same period were selected as control group. The clinical characteristics of children with Kawasaki disease in the two groups and the differences in laboratory indicators among the groups were analyzed and compared. Results The incidence of rash,conjunctival congestion and cervical lymph node enlargement in the IKD group was lower than those in the KD group(P<0.01),and there was no significant difference in the incidence of changes of strawberry tongue and limb in the IKD group compared with the KD group(P>0.05). The blood NT-proBNP,TNF-α,CRP,ESR,WBC and ALT levels in group IKD and group KD were significantly higher than those in the control group(P<0.01). There was no significant difference in blood NT-proBNP,TNF-α,CRP,ESR,WBC and ALT between group IKD and KD group(P>0.05). Conclusion The levels of expression of NT-proBNP and TNF-α were high in the acute stage of incomplete Kawasaki disease. The combined determination of NT-proBNP and TNF-α concentrations in peripheral blood might be used as a laboratory reference for early diagnosis of incomplete Kawasaki disease.
引文
[1]闫辉,杜军保.川崎病的临床诊治探索任重道远[J].中国实用儿科杂志,2017,32(8):561-564.
[2]蒋伟明.1岁以下婴儿川崎病的临床分析[J].中国热带医学,2015,15(9):1124-1126.
[3]张新刚.N端脑利钠肽前体在儿科疾病中诊断及预测价值的研究进展[J].国际儿科学杂志,2018,45(5):380-383.
[4]胡亚美,江载芳,申昆玲,等.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社,2015.
[5]Ram Krishna M,Sundaram B,Dhanalakshmi K.Predictors ofcoronary artery aneurysms in Kawasaki disease[J].Clin Pediatr,2014,53(6):561-565.
[6]时艳艳,刘芳,吴琳,等.川崎病冠状动脉病变严重程度临床分级及高危因素研究[J].中国实用儿科杂志,2014,29(9):681-686.
[7]刘丁,杨方.典型川崎病与不完全川崎病的临床特点单中心比较分析[J].临床荟萃,2018,33(3):236-239.
[8]花旺,龚方戚.不完全型川崎病临床特征[J].中国实用儿科杂志,2017,32(8):572-575.
[9]彭昌,罗月静,幸前鲁,等.儿童不完全川崎病的临床特点分析[J].中国当代儿科杂志,2016,18(11):1111-1114.
[10]武万良,蒋宁,史延,等.N端脑利钠肽前体在川崎病急性期的变化及临床价值[J].中国小儿急救医学,2016,23(8):561-564.
[11]Sato YZ,Molkara DP,Daniels LB,et al.Cardiovascular biomarkers in acute Kawasaki disease[J].Int J Cardiol,2013,164(1):58-63.
[12]汪江萍,林春旺,刘自光.不完全川崎病患儿N端脑钠肽前及心肌肌钙蛋白Ι含量变化的临床意义[J].热带医学杂志,2011,11(6):665-667.
[13]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,2012,44(5):657-659.
[14]卢慧玲,刘亚萍,胡秀芬.N端脑钠肽前体在早期预测川崎病冠状动脉病变中的意义[J].中华儿科杂志,2015,53(4):300-303.
[15]Yilmazer MM,Oner T,Gukalp S,et al.Risk factors for persistenceof coronary artery abnormalities in Turkish children with Kawasakidisease[J].Turk J Pediatr,2015,57(3):248-253.
[16]毛剑虹,徐芝芳.川崎病患儿血清MMP-9、IL-6和TNF-α的变化及临床意义[J].浙江临床医学,2014,16(10):1654-1655.775
[17]钟威达,陈元花,龙新.CRP、TNF-α及IgG在川崎病患儿中的变化及其意义[J].海南医学,2017,28(2):240-242.
[18]林瑶,李晓慧,石琳,等.2017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):641-648.2018-09-25
[2]蒋伟明.1岁以下婴儿川崎病的临床分析[J].中国热带医学,2015,15(9):1124-1126.
[3]张新刚.N端脑利钠肽前体在儿科疾病中诊断及预测价值的研究进展[J].国际儿科学杂志,2018,45(5):380-383.
[4]胡亚美,江载芳,申昆玲,等.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社,2015.
[5]Ram Krishna M,Sundaram B,Dhanalakshmi K.Predictors ofcoronary artery aneurysms in Kawasaki disease[J].Clin Pediatr,2014,53(6):561-565.
[6]时艳艳,刘芳,吴琳,等.川崎病冠状动脉病变严重程度临床分级及高危因素研究[J].中国实用儿科杂志,2014,29(9):681-686.
[7]刘丁,杨方.典型川崎病与不完全川崎病的临床特点单中心比较分析[J].临床荟萃,2018,33(3):236-239.
[8]花旺,龚方戚.不完全型川崎病临床特征[J].中国实用儿科杂志,2017,32(8):572-575.
[9]彭昌,罗月静,幸前鲁,等.儿童不完全川崎病的临床特点分析[J].中国当代儿科杂志,2016,18(11):1111-1114.
[10]武万良,蒋宁,史延,等.N端脑利钠肽前体在川崎病急性期的变化及临床价值[J].中国小儿急救医学,2016,23(8):561-564.
[11]Sato YZ,Molkara DP,Daniels LB,et al.Cardiovascular biomarkers in acute Kawasaki disease[J].Int J Cardiol,2013,164(1):58-63.
[12]汪江萍,林春旺,刘自光.不完全川崎病患儿N端脑钠肽前及心肌肌钙蛋白Ι含量变化的临床意义[J].热带医学杂志,2011,11(6):665-667.
[13]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,2012,44(5):657-659.
[14]卢慧玲,刘亚萍,胡秀芬.N端脑钠肽前体在早期预测川崎病冠状动脉病变中的意义[J].中华儿科杂志,2015,53(4):300-303.
[15]Yilmazer MM,Oner T,Gukalp S,et al.Risk factors for persistenceof coronary artery abnormalities in Turkish children with Kawasakidisease[J].Turk J Pediatr,2015,57(3):248-253.
[16]毛剑虹,徐芝芳.川崎病患儿血清MMP-9、IL-6和TNF-α的变化及临床意义[J].浙江临床医学,2014,16(10):1654-1655.775
[17]钟威达,陈元花,龙新.CRP、TNF-α及IgG在川崎病患儿中的变化及其意义[J].海南医学,2017,28(2):240-242.
[18]林瑶,李晓慧,石琳,等.2017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):641-648.2018-09-25