D - 二聚体、凝血酶原时间及红细胞分布宽度对急性期川崎病患儿冠状动脉病变的诊断效能
Diagnostic performances of D-dimer, prothrombin time, and red blood cell distribution width for coronary artery lesion in children with acute stage Kawasaki disease.
作者信息
Yin Qi-Gai, Zhou Jing, Zhou Qin, Shen Lu, Zhang Mei-Yu, Wu Yan-Hui
机构信息
Department of Pediatrics, The People's Hospital of Suzhou New District, Suzhou, China.
Department of Pediatrics, Lianyungang Clinical Medical College, Nanjing Medical University, Lianyungang, China.
出版信息
Front Pediatr. 2023 Jul 25;11:1141158. doi: 10.3389/fped.2023.1141158. eCollection 2023.
AIM
To evaluate the performances of D-dimer, prothrombin time (PT), and red blood cell distribution width (RDW) for the diagnosis of coronary artery lesion (CAL) in acute stage Kawasaki disease (KD).
METHODS
Between January 2018 and January 2021, a total of 102 children with acute stage KD were included in this retrospective study. Among them, 36 KD children with CAL were divided into the CAL group, and 66 KD children without CAL were divided into the NCAL group. Independent predictors of CAL in acute stage KD were identified by using univariate and multivariate logistic regression analysis. Spearman correlations were used to evaluate the association between CAL in acute stage KD and different indicators. The diagnostic performance of different indicators for CAL in acute stage KD was analyzed by the receiver operating characteristic (ROC) curve.
RESULTS
Compared with the NCAL group, children in the CAL group had significantly higher white blood cell count, lymphocyte count, platelet count, D-dimer, and RDW levels, but lower PT levels (all < 0.05). Logistic regression analysis revealed that D-dimer (OR = 1.0, 95% CI: 1.004-1.012, < 0.001), PT (OR = 0.4, 95% CI: 0.2-0.8, = 0.01), and RDW (OR = 7.0, 95% CI: 2.6-19.2, < 0.001) were independent predictors of CAL in children with acute stage KD. CAL showed a positive correlation with D-dimer ( = 0.4, < 0.001) and RDW ( = 0.5, < 0.001), and had a negative association with PT ( = -0.2, < 0.05). The ROC curve analysis showed that the combination of the three indicators had the highest diagnostic performance for CAL in acute stage KD with an area under the curve (AUC) of 0.922 (sensitivity, 86.1%; specificity, 89.4%), compared with D-dimer (AUC = 0.736), PT (AUC = 0.640), and RDW (AUC = 0.819) alone.
CONCLUSION
A combination of D-dimer, PT, and RDW may help predict CAL in children with acute stage KD.
目的
评估D-二聚体、凝血酶原时间（PT）和红细胞分布宽度（RDW）在诊断急性期川崎病（KD）冠状动脉病变（CAL）中的表现。
方法
2018年1月至2021年1月，本回顾性研究共纳入102例急性期KD患儿。其中，36例合并CAL的KD患儿分为CAL组，66例无CAL的KD患儿分为非CAL组（NCAL组）。采用单因素和多因素logistic回归分析确定急性期KD合并CAL的独立预测因素。采用Spearman相关性分析评估急性期KD合并CAL与不同指标之间的关联。通过绘制受试者工作特征（ROC）曲线分析不同指标对急性期KD合并CAL的诊断效能。
结果
与NCAL组相比，CAL组患儿的白细胞计数、淋巴细胞计数、血小板计数、D-二聚体和RDW水平显著升高，但PT水平较低（均P<0.05）。logistic回归分析显示，D-二聚体（OR=1.0，95%CI：1.004-1.012，P<0.001）、PT（OR=0.4，95%CI：0.2-0.8，P=0.01）和RDW（OR=7.0，95%CI：2.6-19.2，P<0.001）是急性期KD患儿合并CAL的独立预测因素。CAL与D-二聚体（r=0.4，P<0.001）和RDW（r=0.5，P<0.001）呈正相关，与PT（r=-0.2，P<0.05）呈负相关。ROC曲线分析显示，与单独的D-二聚体（AUC=0.736）、PT（AUC=0.640）和RDW（AUC=0.819）相比，这三项指标联合检测对急性期KD合并CAL的诊断效能最高，曲线下面积（AUC）为0.922（敏感性为86.1%，特异性为89.4%）。
结论
D-二聚体、PT和RDW联合检测可能有助于预测急性期KD患儿合并CAL。
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