Dahdah Nagib, Siles Ana, Fournier Anne, Cousineau Jocelyne, Delvin Edgard, Saint-Cyr Claire, Spiegelblatt Linda, Bonny Yvette, Vartian Michèle, Montigny Martine
Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montréal, QC H3T 1C5, Canada.
Pediatr Cardiol. 2009 Aug;30(6):810-7. doi: 10.1007/s00246-009-9441-2. Epub 2009 Apr 14.
Coronary arteritis rather than myocardial involvement is typically emphasized in Kawasaki disease (KD). Moreover, the criteria and the usual biological markers oversee the importance of cardiac-specific markers in diagnosing this disease. We sought to study the clinical usefulness of measuring B-type natriuretic peptide (BNP) and its N-terminal moiety (NT-proBNP) at the onset of KD. Our objective was to evaluate blood concentrations of BNP and NT-proBNP during the acute and subacute phases of KD. We conducted a prospective study comparing newly diagnosed KD patients to non-KD febrile controls. Blood specimens were collected at presentation, 6-12 h after intravenous immunoglobulin (IVIG) therapy, 1-2 weeks later, and 2-3 months later, or only upon reenrollment for controls. Forty-there KD and 19 control patients were enrolled consecutively. The mean age was 47.1 +/- 34.3 and 62.2 +/- 44.9 months, respectively (p = NS). Pre-IVIG NT-proBNP levels were significantly higher in KD patients than in controls (923.6 +/- 1361.7 vs. 186.2 +/- 198.0 ng/L; p < 0.001), with no statistical difference for BNP (141.9 +/- 227.5 vs. 59.9 +/- 72.4 ng/L; p = 0.112). In conclusion, our data indicate that NT-proBNP is a better marker of myocardial involvement in acute KD than BNP, particularly in cases with incomplete diagnostic criteria, and suggest that it may be a valid adjunctive diagnostic method to support the diagnosis of KD.
川崎病（KD）通常强调的是冠状动脉炎而非心肌受累。此外，诊断标准和常用的生物学标志物忽视了心脏特异性标志物在诊断该疾病中的重要性。我们试图研究在KD发病时测量B型利钠肽（BNP）及其N端片段（NT-proBNP）的临床实用性。我们的目的是评估KD急性期和亚急性期BNP和NT-proBNP的血浓度。我们进行了一项前瞻性研究，将新诊断的KD患者与非KD发热对照进行比较。在就诊时、静脉注射免疫球蛋白（IVIG）治疗后6 - 12小时、1 - 2周后、2 - 3个月后采集血标本，对照组仅在再次登记时采集。连续纳入43例KD患者和19例对照患者。平均年龄分别为47.1±34.3个月和62.2±44.9个月（p =无显著性差异）。KD患者IVIG治疗前NT-proBNP水平显著高于对照组（923.6±1361.7 vs. 186.2±198.0 ng/L；p < 0.001），BNP无统计学差异（141.9±227.5 vs. 59.9±72.4 ng/L；p = 0.112）。总之，我们的数据表明，NT-proBNP在急性KD中比BNP是更好的心肌受累标志物，特别是在诊断标准不完整的病例中，并表明它可能是支持KD诊断的一种有效的辅助诊断方法。
