Xu Xinle, Wang Jin
Department of Pediatrics, Hangzhou Linping District Maternal and Child Health Hospital,Zhejiang, China.
Department of Child Health, Hangzhou Linping District Maternal and Child Health Hospital, Zhejiang, China.
Arch Rheumatol. 2025 Jun 23;40(2):256-266. doi: 10.5152/ArchRheumatol.2025.11128.
Background/Aims: Kawasaki disease (KD) is often complicated by coronary artery lesions (CAL). Identifying reliable biomarkers may improve early diagnosis and risk stratification for CAL, facilitating timely intervention. This study aims to investigate the diagnostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in KD complicated with CAL. Materials and Methods: PubMed, Scopus, Web of Science, Embase, and the Cochrane Library databases were searched from inception to November 30, 2024 for English-language studies comparing NT-proBNP levels in KD patients with and without CAL. Diagnostic accuracy metrics for NT-proBNP in detecting CAL were also analyzed. The analysis was performed using a random-effects model. I² statistics assessed the heterogeneity. NT-proBNP levels reported as medians were converted to means using established formulas. Results: Nineteen studies involving 9017 participants showed significantly higher NT-proBNP levels in KD patients with CAL (pooled standardized mean differences = 1.889, 95% CI: 1.274 to 2.504, P < .001), with substantial heterogeneity (I² = 98.5%). Eighteen studies assessed diagnostic accuracy, yielding pooled sensitivity and specificity of 0.78 (95% CI: 0.68-0.85) and 0.78 (95% CI: 0.70-0.84), respectively. The diagnostic odds ratio was 12 (95% CI: 7-21), with an area under the receiver operating characteristic curve (AUROC) of 0.85 (95% CI: 0.81-0.88), indicating good diagnostic performance. However, heterogeneity remained significant (I² = 99%). Conclusion: N-terminal pro-brain natriuretic peptide is a promising biomarker for detecting CAL in KD, with good diagnostic accuracy. While elevated NT-proBNP levels correlate with CAL, its role is best realized as part of a multimodal diagnostic approach. Future research should focus on standardization and validation across diverse populations.
背景/目的：川崎病（KD）常并发冠状动脉病变（CAL）。识别可靠的生物标志物可能有助于改善CAL的早期诊断和风险分层，从而促进及时干预。本研究旨在探讨N端脑钠肽前体（NT-proBNP）在KD合并CAL中的诊断价值。材料与方法：检索PubMed、Scopus、Web of Science、Embase和Cochrane图书馆数据库，从建库至2024年11月30日，查找比较有和没有CAL的KD患者NT-proBNP水平的英文研究。还分析了NT-proBNP检测CAL的诊断准确性指标。采用随机效应模型进行分析。I²统计量评估异质性。将报告为中位数的NT-proBNP水平使用既定公式转换为均值。结果：19项研究涉及9017名参与者，结果显示KD合并CAL患者的NT-proBNP水平显著更高（合并标准化均值差=1.889，95%CI：1.274至2.504，P<.001），存在显著异质性（I²=98.5%）。18项研究评估了诊断准确性，合并敏感性和特异性分别为0.78（95%CI：0.68 - 0.85）和0.78（95%CI：0.70 - 0.84）。诊断比值比为12（95%CI：7 - 21），受试者工作特征曲线下面积（AUROC）为0.85（95%CI：0.81 - 0.88），表明诊断性能良好。然而，异质性仍然显著（I²=99%）。结论：N端脑钠肽前体是检测KD中CAL的一种有前景的生物标志物，具有良好的诊断准确性。虽然NT-proBNP水平升高与CAL相关，但其作用最好作为多模式诊断方法的一部分来实现。未来的研究应侧重于不同人群的标准化和验证。
