李鹏 周忠蜀

[摘要] 目的 评价川崎病患者急性期血清降钙素原（PCT）水平的变化对冠状动脉损害的预估价值。 方法 回顾性分析2011年4月～2014年12月中日友好医院住院的51例川崎病患者的临床资料。按照有无冠状动脉损害，分为冠状动脉损害组（CAL组，22例）和无冠状动脉损害组（nCAL组，29例），选取同期住院的急性病毒感染患者24例作为对照组。所有入组患者均在入院后24 h内取血，采用免疫荧光法检测血清PCT。采用Mann-Whitney U 检验比较各组间PCT水平的差异，采用卡方检验及ROC曲线分析评估PCT对冠状动脉损害的预估价值。 结果 川崎病患者血清PCT水平[0.50（0.12～1.63）μg/L]较对照组[0.11（0.05～0.24）μg/L]显著升高，差异有高度统计学意义（P < 0.01）。CAL组血清PCT水平[0.20（0.07～1.15）μg/L]较nCAL组[0.96（0.17～2.10）μg/L]降低，但差异无统计学意义（P > 0.05）。卡方检验提示PCT阴性可作为川崎病患者冠状动脉损害的预测因子（χ2=4.42，P < 0.05）。ROC曲线分析显示，当选取PCT≤0.34 μg/L作为临界点时，对冠状动脉损害预测的灵敏度为0.682，特异度为0.655（95%CI：0.511～0.785，P < 0.05）。 结论 川崎病患者急性期血清PCT水平较病毒感染患者明显升高，血清PCT水平对川崎病患者急性期冠状动脉损害有一定的阴性预测价值。

[关键词] 降钙素原；川崎病；冠状动脉损害；免疫球蛋白

[中图分类号] R725.4 [文献标识码] A [文章编号] 1673-7210（2015）06（b）-0088-04

Predictive value of serum procalcitonin level on coronary artery lesion in patients with Kawasaki disease

LI Peng1，2 ZHOU Zhongshu1，2

1.Department of Pediatrics， China-Japan Friendship Hospital， Beijing 100029， China； 2.Graduate School of Peking Union Medical College， Beijing 100730， China

[Abstract] Objective To assess the predictive value of serum procalcitonin （PCT） level on coronary artery lesion （CAL） in the acute phase of Kawasaki disease （KD）. Methods Clinical data of 51 KD patients hospitalized in China-Japan Friendship Hospital from April 2011 to December 2014 were retrospectively analyzed. The KD patients were divided into CAL group （n=22） and nCAL group （n=29） according to the presence or absence of CAL in the acute phase， and 24 patients with acute viral infection during the same period were also enrolled in this study as a control group. Blood samples of all patients were obtained in 24 hours of admission and PCT levels were detected by immunofluorescence technique. Mann-Whitney U tests were used to assess the statistical significance of PCT value among the different groups. χ2 test and receiver operating characteristics （ROC） curve analysis were performed to explore the power of serum PCT level in predicting the CAL in the acute phase of KD. Results The level of serum PCT in KD patients [0.50（0.12-1.63） μg/L] was statistically higher than that in control group [0.11 （0.05-0.24） μg/L] （P < 0.01）. The serum PCT value in CAL group [0.20 （0.07-1.15） μg/L] was lower than that in nCAL group [0.96 （0.17-2.10） μg/L]， but there was no statistical significance （P > 0.05）. The χ2 test showed that， PCT negative was a predictive factor of CAL in KD patients（χ2=4.42， P < 0.05）. ROC curve analysis indicated that， PCT≤0.34 μg/L was the cutoff value， the sensitivity was 0.682 and the specialty was 0.655 （95%CI： 0.511-0.785， P < 0.05）. Conclusion The level of serum PCT in KD patients is statistically higher than that in patients with viral infection. Serum PCT level has some negative predictive value on CAL in the acute phase of KD patients.

[Key words] Procalcitonin； Kawasaki disease； Coronary artery lesion； Intravenous immunoglobulin

川崎病（Kawasaki disease，KD）是一种以全身中小动脉非特异性炎症为主要病理改变的发热性出疹性疾病，部分患者可有冠状动脉受累[1]。在一些发达国家，川崎病所致的冠状动脉损害（coronary artery lesion，CAL）已逐渐成为儿童获得性心脏病的首要原因[2]。早期应用大剂量丙种球蛋白（intravenous immunoglobulin，IVIG）有助于降低冠状动脉损害的发生率[3]，但部分患儿对IVIG不敏感，故探讨冠状动脉损害的易感因素对于川崎病的临床诊治将有重要的指导意义。近期研究发现降钙素原（procalcitonin，PCT）水平增高和川崎病的发生密切相关，而PCT是否可以作为川崎病冠状动脉损害的预测因子，目前尚存在争议[4-7]。为了探讨川崎病患者急性期血清PCT水平和冠状动脉损害的相关性，特开展本研究。……