血清HMGB1、Angptl-2对川崎病患儿冠状动脉损害的预测价值

doi:10.11958/20242018

摘要/Abstract

摘要：

目的探究高迁移率族蛋白B1（HMGB1）和血管生成素样蛋白2（Angptl-2）对川崎病患儿合并冠状动脉损害的影响及预测价值。方法选取114例川崎病患儿，根据是否发生冠状动脉损害分为冠状动脉正常组（85例）和冠状动脉损害组（29例），比较2组一般临床资料；酶联免疫吸附试验检测患儿血清中HMGB1和Angptl-2水平并进行比较；Logistic回归分析川崎病患儿发生冠状动脉损害的影响因素；受试者工作特征（ROC）曲线分析血清中HMGB1和Angptl-2水平对川崎病患儿发生冠状动脉损害的预测价值。结果急性发作期患儿血清HMGB1和Angptl-2水平明显高于缓解期（P<0.01）；冠状动脉损害组患儿治疗前发热时间、白细胞计数、红细胞沉降率、降钙素原以及血清HMGB1和Angptl-2水平均明显高于冠状动脉正常组（P<0.05）。Logistic回归结果显示，治疗前发热时间长，白细胞计数、红细胞沉降率、降钙素原、HMGB1、Angptl-2水平升高均是川崎病患儿发生冠状动脉损害的独立危险因素（P<0.05）。血清HMGB1、Angptl-2诊断川崎病患儿发生冠状动脉损害的曲线下面积（AUC）分别为0.907（95%CI：0.838~0.953）、0.857（95%CI：0.780~0.916），截断值分别为59.62 μg/L、10.35 μg/L。二者联合诊断的AUC为0.958（95%CI：0.903~0.987），敏感度为93.10%，特异度为90.59%，优于各自单独诊断。结论川崎病合并冠状动脉损害患儿血清HMGB1、Angptl-2均明显升高，两者联合检测有助于预测川崎病患儿冠状动脉损害的发生。

关键词: 黏膜皮肤淋巴结综合征, 冠状动脉损害, 高迁移率族蛋白B1, 血管生成素样蛋白2

Abstract:

Objective To investigate the impact and predictive value of high mobility group protein B1 (HMGB1) and angiopoietin like protein 2 (Angptl-2) on coronary artery damage in children with Kawasaki disease. Methods A total of 114 children with Kawasaki disease were selected and divided into the normal coronary artery group (85 cases) and the coronary artery lesion group (29 cases) according to the presence or absence of coronary artery lesions. The general clinical data of the two groups were compared. Enzyme linked immunosorbent assay was applied to detect serum levels of HMGB1 and Angptl-2 in children and compared between the two groups. Logistic regression was applied to analyze the influencing factors of coronary artery damage in children with Kawasaki disease. Receiver operating curve (ROC) was applied to analyze the predictive value of serum levels of HMGB1 and Angptl-2 for coronary artery damage in children with Kawasaki disease. Results The serum levels of HMGB1 and Angptl-2 were significantly higher in acute stage than those in remission stage (P<0.05). Before treatment, the duration of fever, white blood cell count, erythrocyte sedimentation rate, procalcitonin and serum HMGB1 and Angptl-2 levels were significantly higher in the coronary artery lesion group than those in the normal coronary artery group (P<0.05). Logistic regression analysis showed that the duration of fever, white blood cell count, erythrocyte sedimentation rate, procalcitonin, HMGB1 and Angptl-2 levels before treatment were all independent risk factors for coronary artery damage in children with Kawasaki disease (P<0.05). The area under the curve (AUC) of serum HMGB1 and Angptl-2 for diagnosing coronary artery damage in children with Kawasaki disease was 0.907 (95%CI: 0.838-0.953) and 0.857 (95%CI:0.780-0.916), respectively, with cut-off value of 59.62 μg/L and 10.35 μg/L, respectively. The AUC, sensitivity and specificity of the combined diagnosis of coronary artery damage in children with Kawasaki disease were 0.958 (95%CI: 0.903-0.987), 93.10% and 90.59%, respectively, which were better than their individual diagnose. Conclusion The serum levels of HMGB1 and Angptl-2 are obviously elevated in children with Kawasaki disease complicated by coronary artery damage, and the combined detection of HMGB1 and Angptl-2 levels in serum can provide a good prediction for coronary artery damage in children with Kawasaki disease.

Key words: mucocutaneous lymph node syndrome, coronary artery damage, high mobility group protein B1, angiopoietin like protein 2

中图分类号:

R725.4

图/表 6

参考文献 20

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疾病分期	n	HMGB1	Angptl-2
急性发作期	114	52.42±7.90	9.09±2.31
缓解期	114	28.15±4.61	5.24±1.12
t		64.256^＊＊	33.786^＊＊

疾病分期	n	HMGB1	Angptl-2
急性发作期	114	52.42±7.90	9.09±2.31
缓解期	114	28.15±4.61	5.24±1.12
t		64.256^＊＊	33.786^＊＊

组别		n		性别（男/女）	年龄/ 岁		BMI/ （kg/m²）		治疗前发热时间/d
冠状动脉正常组		85		46/39	3.32±0.48		20.11±2.10		3.80±0.69
冠状动脉损害组		29		21/8	3.15±0.45		20.04±2.06		5.91±1.71
χ²或t				2.987	1.672		0.156		8.604^＊＊
组别	Hb/ （g/L）				Alb/ （g/L）		PLT/ （×10⁹/L）		WBC/ （×10⁹/L）
冠状动脉正常组	104.12±13.79				37.13±5.02		371.59±80.75		11.96±3.02
冠状动脉损害组	103.75±12.88				36.85±4.98		365.42±79.26		13.75±3.27
t	0.127				0.510		0.357		2.699^＊＊
组别			CRP/（mg/L）			ESR/（mm/1 h）		PCT/（μg/L）
冠状动脉正常组			54.45±7.22			49.74±6.24		0.62±0.11
冠状动脉损害组			56.21±7.59			59.28±7.83		1.09±0.25
t			1.119			6.794^＊＊		13.906^＊＊

组别		n		性别（男/女）	年龄/ 岁		BMI/ （kg/m²）		治疗前发热时间/d
冠状动脉正常组		85		46/39	3.32±0.48		20.11±2.10		3.80±0.69
冠状动脉损害组		29		21/8	3.15±0.45		20.04±2.06		5.91±1.71
χ²或t				2.987	1.672		0.156		8.604^＊＊
组别	Hb/ （g/L）				Alb/ （g/L）		PLT/ （×10⁹/L）		WBC/ （×10⁹/L）
冠状动脉正常组	104.12±13.79				37.13±5.02		371.59±80.75		11.96±3.02
冠状动脉损害组	103.75±12.88				36.85±4.98		365.42±79.26		13.75±3.27
t	0.127				0.510		0.357		2.699^＊＊
组别			CRP/（mg/L）			ESR/（mm/1 h）		PCT/（μg/L）
冠状动脉正常组			54.45±7.22			49.74±6.24		0.62±0.11
冠状动脉损害组			56.21±7.59			59.28±7.83		1.09±0.25
t			1.119			6.794^＊＊		13.906^＊＊

组别	n	HMGB1	Angptl-2
冠状动脉正常组	85	49.71±7.09	8.15±1.96
冠状动脉损害组	29	60.38±8.13	11.83±2.59
t		6.738^＊＊	8.015^＊＊