Liu Zhen-Qing, Jia Wan-Yu, Li Peng, Song Chun-Lan
Emergency medicine department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, No. 1, South University Road, Erqi District, Zhengzhou, 450052, Henan, China.
Ital J Pediatr. 2025 Jul 15;51(1):229. doi: 10.1186/s13052-025-02076-7.
To compare the expression levels of serum ferritin and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in children over 1 year with Kawasaki disease (KD) and explore the early predictive value of the combined detection of these two indicators for the occurrence of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in KD patients.
A total of 320 children over 1 year of age with KD were retrospectively studied. All participants had peripheral blood samples collected at specific times to test laboratory indicators such as serum ferritin and NT-proBNP. The patients were divided into an IVIG-resistant group and an IVIG-responsive group on the basis of the initial IVIG treatment effect. According to the results of cardiac ultrasound, the patients were divided into a CAL group and a non-CAL group. SPSS 25.0 software was used for data analysis. Receiver operating characteristic (ROC) curves were used to evaluate the early diagnostic efficacy of various indicators for IVIG resistance and CALs in KD patients.
Logistic regression analysis revealed that the neutrophil percentage and duration of fever before initial IVIG were independent influencing factors of IVIG resistance in KD patients. IVIG resistance, duration of fever before initial IVIG, and serum albumin level were found to be independent influencing factors of CALs. ROC curve analysis revealed that the area under the curve (AUC) of NT-proBNP for identifying IVIG resistance in KD patients was 0.698. When the cutoff value of NT-proBNP was 419.6 pg/mL, the diagnostic efficacy for IVIG resistance in KD patients was the highest, with a sensitivity of 81.3% and a specificity of 53.0%. The ROC curve analysis revealed that the AUC of NT-proBNP combined with serum ferritin for identifying CALs in KD patients was 0.666, and the diagnostic efficiency of CALs was the highest.
In children over 1 year of age with KD, the level of NT-proBNP could be used as an early predictor of IVIG resistance and CALs, and the serum ferritin level could be used as an early predictor of CALs. The diagnostic efficacy of CALs can be further improved when NT-proBNP and serum ferritin are jointly detected.
比较1岁以上川崎病（KD）患儿血清铁蛋白和血浆N末端脑钠肽前体（NT-proBNP）的表达水平，探讨联合检测这两项指标对KD患儿静脉注射免疫球蛋白（IVIG）抵抗及冠状动脉病变（CALs）发生的早期预测价值。
回顾性研究320例1岁以上KD患儿。所有参与者在特定时间采集外周血样本，检测血清铁蛋白和NT-proBNP等实验室指标。根据初始IVIG治疗效果将患者分为IVIG抵抗组和IVIG敏感组。根据心脏超声结果，将患者分为CAL组和非CAL组。采用SPSS 25.0软件进行数据分析。采用受试者操作特征（ROC）曲线评估各指标对KD患者IVIG抵抗和CALs的早期诊断效能。
Logistic回归分析显示，中性粒细胞百分比和初始IVIG治疗前发热持续时间是KD患者IVIG抵抗的独立影响因素。发现IVIG抵抗、初始IVIG治疗前发热持续时间和血清白蛋白水平是CALs的独立影响因素。ROC曲线分析显示，NT-proBNP识别KD患者IVIG抵抗的曲线下面积（AUC）为0.698。当NT-proBNP的截断值为419.6 pg/mL时，对KD患者IVIG抵抗的诊断效能最高，敏感性为81.3%，特异性为53.0%。ROC曲线分析显示，NT-proBNP联合血清铁蛋白识别KD患者CALs的AUC为0.666，对CALs的诊断效率最高。
在1岁以上KD患儿中，NT-proBNP水平可作为IVIG抵抗和CALs的早期预测指标，血清铁蛋白水平可作为CALs的早期预测指标。联合检测NT-proBNP和血清铁蛋白可进一步提高CALs的诊断效能。
