血清透明质酸酶-1 对川崎病患者冠状动脉病变的诊断价值及实验室指标的相关性分析。
Diagnostic value of syndecan-1 for coronary artery lesions and correlation analysis of laboratory indicators in Kawasaki disease patients.
机构信息
ICU Department, Wuhan No.1 Hospital, Wuhan, Hubei, China.
Cardiothoracic Surgery Department, The People's Hospital of Lincang, No. 116 Nantang Road, Linxiang District, Lincang, Yunnan, China.
出版信息
Ital J Pediatr. 2024 Oct 9;50(1):209. doi: 10.1186/s13052-024-01772-0.
BACKGROUND
To explore the application value of syndecan-1 (SDC-1) in the diagnosis of coronary artery lesions (CALs) in Kawasaki disease (KD) patients and the correlation of multiple laboratory indicators in KD patients.
METHODS
86 pediatric Kawasaki disease (KD) patients and 52 healthy controls admitted from January 2018 to December 2023 were retrospectively analyzed. Venous blood samples from KD patients were analyzed for white blood cells (WBC), platelets (PLT), C-reactive protein (CRP), interleukin-6 (IL-6), syndecan-1 (SDC-1), coagulation parameters, and lipid profiles. Correlations between these laboratory indicators were assessed. Receiver operating characteristic (ROC) curve analysis determined the diagnostic value of SDC-1 for coronary artery lesions (CALs) in KD patients. SDC-1 levels were further compared across different CAL severity groups.
RESULTS
The levels of ALT, AST, WBC, PLT, CRP, IL-6, and SDC-1 in the KD group were significantly higher than those in the control group (P < 0.05). Coagulation function analysis showed that APTT, TT and FIB levels were significantly increased in the KD group compared with the control group (P < 0.05). Lipid profile analysis revealed that TC, HDL-C, and ApoA1 were significantly decreased, whereas TG, LDL-C, and ApoB100 were significantly increased in the KD group (P < 0.05). Refractory KD patients exhibited significantly higher levels of ALT, AST, SDC-1, CRP, WBC, and TG compared to responsive KD patients (P < 0.05). Correlation analysis indicated a strong positive correlation between PLT and LDL-C (r = 0.227, P = 0.035) and between IL-6 and TG (r = 0.491, P = 0.000), while CRP was negatively correlated with ApoA1 (r = -0.265, P = 0.014). Among the 86 KD patients, 41 (47.67%) developed CALs, with 19 classified as mild, 15 as moderate, and 7 as severe. For predicting CALs among KD patients, the threshold of SDC-1 was identified as 5.5 ng/ml, with a sensitivity of 70.7%, specificity of 64.4%, positive predictive value of 65.91%, negative predictive value of 69.05%, and an AUC of 0.762 (95% confidence interval 0.662-0.861, P < 0.001). SDC-1 levels significantly differed among the CAL severity groups (P = 0.008), with higher levels observed in moderate compared to mild CALs, and in severe compared to moderate CALs.
CONCLUSION
In conclusion, SDC-1 has strong clinical value in the diagnosis of CALs in KD patients, and there is a close relationship between the levels of inflammatory factors, coagulation function and lipid levels in KD patients.
背景
探讨硫酸乙酰肝素蛋白聚糖-1（SDC-1）在川崎病（KD）患者冠状动脉病变（CALs）诊断中的应用价值及KD 患者多项实验室指标的相关性。
方法
回顾性分析 2018 年 1 月至 2023 年 12 月收治的 86 例儿科川崎病（KD）患儿和 52 例健康对照者的临床资料。KD 患儿采集静脉血检测白细胞（WBC）、血小板（PLT）、C 反应蛋白（CRP）、白细胞介素-6（IL-6）、硫酸乙酰肝素蛋白聚糖-1（SDC-1）、凝血参数和血脂谱，评估各实验室指标之间的相关性。采用受试者工作特征（ROC）曲线分析 SDC-1 对 KD 患儿冠状动脉病变（CALs）的诊断价值。进一步比较不同 CAL 严重程度组之间的 SDC-1 水平。
结果
KD 组 ALT、AST、WBC、PLT、CRP、IL-6 和 SDC-1 水平均明显高于对照组（P<0.05）。凝血功能分析显示，KD 组 APTT、TT 和 FIB 水平明显高于对照组（P<0.05）。血脂谱分析显示，KD 组 TC、HDL-C 和 ApoA1 明显降低，而 TG、LDL-C 和 ApoB100 明显升高（P<0.05）。难治性 KD 患儿的 ALT、AST、SDC-1、CRP、WBC 和 TG 水平明显高于反应性 KD 患儿（P<0.05）。相关性分析表明，PLT 与 LDL-C 呈强正相关（r=0.227，P=0.035），IL-6 与 TG 呈强正相关（r=0.491，P=0.000），而 CRP 与 ApoA1 呈负相关（r=-0.265，P=0.014）。在 86 例 KD 患儿中，41 例（47.67%）发生 CALs，其中轻度 19 例，中度 15 例，重度 7 例。预测 KD 患儿 CALs 时，SDC-1 阈值为 5.5ng/ml，灵敏度为 70.7%，特异性为 64.4%，阳性预测值为 65.91%，阴性预测值为 69.05%，AUC 为 0.762（95%CI：0.662-0.861，P<0.001）。SDC-1 水平在 CAL 严重程度组间差异有统计学意义（P=0.008），中重度 CAL 患儿 SDC-1 水平明显高于轻度 CAL 患儿，重度 CAL 患儿 SDC-1 水平明显高于中重度 CAL 患儿。
结论
综上所述，SDC-1 在 KD 患儿 CALs 的诊断中有较强的临床价值，KD 患者的炎症因子、凝血功能和血脂水平之间存在密切关系。
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