Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.
Department of Emergency Medicine, Seoul Medical Center, Jungang-gu, Seoul, Republic of Korea.
Am J Emerg Med. 2019 Mar;37(3):468-471. doi: 10.1016/j.ajem.2018.06.021. Epub 2018 Jun 8.
Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4 days of fever) of KD.
Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24 h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1 month to 15 years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014.
One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24 h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1 pg/ml; interquartile range [IQR], 515.4-1570.0184.8-767.8 pg/ml) than in patients without CAD (396.4 pg/ml; IQR, 184.8-767.8 pg/ml) (p ≤ 0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4 pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642-0.856).
Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED.
冠状动脉扩张（CAD）是川崎病（KD）的一大关注点。本研究旨在探讨急性期（发热≤4 天）KD 患者血清 N 端脑利钠肽前体（NT-proBNP）水平与 CAD 的关系。
在儿科急诊部（PED）急性期 24 小时内行经胸超声心动图（TTE）的 KD 患者中，比较 CAD 患者与非 CAD 患者的血清 NT-proBNP 水平。回顾性评估 2010 年 1 月至 2014 年 12 月 31 日期间，PED 就诊的 1 个月至 15 岁患者的电子病历。
共纳入 109 例患者，其中 23 例患者在 TTE 后 24 小时内发生 CAD。CAD 患者的中位血清 NT-proBNP 水平显著高于非 CAD 患者（824.1pg/ml；四分位距[IQR]：515.4-1570.0；824.8-767.8pg/ml）（p≤0.001）。预测 KD 急性期 CAD 的血清 NT-proBNP 截断值为 515.4pg/ml，其敏感性为 78.26%，特异性为 61.63%。NT-proBNP 预测 KD 急性期 CAD 的曲线下面积为 0.749（95%CI：0.642-0.856）。
血清 NT-proBNP 可能是 PED 急性期 KD 早期 CAD 的附加实验室标志物。
