Kaneko Kazunari, Yoshimura Ken, Ohashi Atsushi, Kimata Takahisa, Shimo Tomohiko, Tsuji Shoji
Department of Pediatrics, Kansai Medical University, Osaka, Japan.
Pediatr Cardiol. 2011 Dec;32(8):1106-9. doi: 10.1007/s00246-011-9986-8. Epub 2011 Apr 13.
Kawasaki disease (KD) is an acute systemic vasculitis associated with the development of coronary arterial lesions (CALs) occurring in 3-5% of children treated by intravenous immune globulin (IVIG). However, a considerable number of patients who are not responding to IVIG are at much higher risk. Although studies have explored potential biomarkers to predict patients with KD who are at risk of CAL, no useful single marker exists. We hypothesized that the serum concentrations of the N-terminal moiety of brain natriuretic peptide (NT-proBNP) can be useful to predict CAL. Forty-three children with KD (29 males and 14 females) were enrolled in this study. Despite IVIG, 6 of the 43 patients developed CAL. There were, however, no significant differences in variables between children with CAL and those without CAL: These include age, gender, day of the illness, leukocyte count, and the serum levels of sodium, C-reactive protein, and albumin. The serum NT-proBNP level was significantly higher in children with CAL than those without CAL (2,611 ± 1,699 vs. 1,073 ± 1,427 pg/ml; P = 0.03): the cutoff value of 1,000 pg/ml to predict CAL produced a specificity of 0.68, sensitivity of 0.83, and an odds ratio as high as 10.4. In conclusion, NT-proBNP is increased in KD patients who are developing CAL, and patients with an elevated serum NT-proBNP >1,000 pg/ml have a risk of CAL ~10 times higher than that of patients with a modest increase.
川崎病（KD）是一种急性全身性血管炎，与冠状动脉病变（CALs）的发生有关，在接受静脉注射免疫球蛋白（IVIG）治疗的儿童中，有3% - 5%会出现这种情况。然而，相当一部分对IVIG无反应的患者风险要高得多。尽管已有研究探索了潜在的生物标志物来预测有CAL风险的KD患者，但尚无有用的单一标志物。我们推测，脑钠肽N端前体（NT - proBNP）的血清浓度可能有助于预测CAL。本研究纳入了43例KD患儿（男29例，女14例）。尽管接受了IVIG治疗，43例患者中有6例出现了CAL。然而，出现CAL的儿童与未出现CAL的儿童在以下变量方面并无显著差异：这些变量包括年龄、性别、发病天数、白细胞计数以及血清钠、C反应蛋白和白蛋白水平。出现CAL的儿童血清NT - proBNP水平显著高于未出现CAL的儿童（2611±1699 vs. 1073±1427 pg/ml；P = 0.03）：预测CAL的截断值为1000 pg/ml时，特异性为0.68，敏感性为0.83，优势比高达10.4。总之，正在发生CAL的KD患者NT - proBNP升高，血清NT - proBNP>1000 pg/ml的患者发生CAL的风险比轻度升高的患者高约10倍。
