Adjagba Philippe M, Desjardins Laurent, Fournier Anne, Spigelblatt Linda, Montigny Martine, Dahdah Nagib
1Division of Pediatric Cardiology,Department of Pediatrics,Centre Hospitalier Universitaire Sainte-Justine,Université de Montréal,Montréal,Quebec,Canada.
4Department of Pediatrics,Maisonneuve Rosemont Hospital,Montréal,Canada.
Cardiol Young. 2015 Oct;25(7):1311-8. doi: 10.1017/S1047951114002431. Epub 2014 Dec 29.
We have lately documented the importance of N-terminal pro-brain natriuretic peptide in aiding the diagnosis of Kawasaki disease.
We sought to investigate the potential value of N-terminal pro-brain natriuretic peptide pertaining to the prediction of coronary artery dilatation (Z-score>2.5) and/or of resistance to intravenous immunoglobulin therapy. We hypothesised that increased serum N-terminal pro-brain natriuretic peptide level correlates with increased coronary artery dilatation and/or resistance to intravenous immunoglobulin.
We carried out a prospective study involving newly diagnosed patients treated with 2 g/kg intravenous immunoglobulin within 5-10 days of onset of fever. Echocardiography was performed in all patients at onset, then weekly for 3 weeks, then at month 2, and month 3. Coronary arteries were measured at each visit, and coronary artery Z-score was calculated. All the patients had N-terminal pro-brain natriuretic peptide serum level measured at onset, and the Z-score calculated.
There were 109 patients enrolled at 6.58±2.82 days of fever, age 3.79±2.92 years. High N-terminal pro-brain natriuretic peptide level was associated with coronary artery dilatation at onset in 22.2 versus 5.6% for normal N-terminal pro-brain natriuretic peptide levels (odds ratio 4.8 [95% confidence interval 1.05-22.4]; p=0.031). This was predictive of cumulative coronary artery dilatation for the first 3 months (p=0.04-0.02), but not during convalescence at 2-3 months (odds ratio 1.28 [95% confidence interval 0.23-7.3]; p=non-significant). Elevated N-terminal pro-brain natriuretic peptide levels did not predict intravenous immunoglobulin resistance, 15.3 versus 13.5% (p=1).
Elevated N-terminal pro-brain natriuretic peptide level correlates with acute coronary artery dilatation in treated Kawasaki disease, but not with intravenous immunoglobulin resistance.
我们最近记录了N端前脑钠肽在辅助诊断川崎病中的重要性。
我们试图研究N端前脑钠肽在预测冠状动脉扩张（Z评分>2.5）和/或静脉注射免疫球蛋白治疗抵抗方面的潜在价值。我们假设血清N端前脑钠肽水平升高与冠状动脉扩张增加和/或静脉注射免疫球蛋白抵抗相关。
我们进行了一项前瞻性研究，纳入了在发热起病5 - 10天内接受2 g/kg静脉注射免疫球蛋白治疗的新诊断患者。所有患者在起病时进行超声心动图检查，然后每周检查1次，持续3周，之后在第2个月和第3个月进行检查。每次就诊时测量冠状动脉，并计算冠状动脉Z评分。所有患者在起病时测量N端前脑钠肽血清水平，并计算Z评分。
共纳入109例患者，发热时间为6.58±2.82天，年龄为3.79±2.92岁。高N端前脑钠肽水平与起病时冠状动脉扩张相关，正常N端前脑钠肽水平者为5.6%，高N端前脑钠肽水平者为22.2%（比值比4.8 [95%置信区间1.05 - 22.4]；p = 0.031）。这可预测前3个月的累积冠状动脉扩张（p = 0.04 - 0.02），但在2 - 3个月恢复期则不能预测（比值比1.28 [95%置信区间0.23 - 7.3]；p = 无显著性差异）。N端前脑钠肽水平升高不能预测静脉注射免疫球蛋白抵抗，分别为15.3%和13.5%（p = 1）。
在接受治疗的川崎病中，N端前脑钠肽水平升高与急性冠状动脉扩张相关，但与静脉注射免疫球蛋白抵抗无关。
