分泌型磷脂酶A2在川崎病早期诊断中的意义

发布时间：2018-05-14 08:50

本文选题：川崎病 + 早期诊断　；参考：《福建医科大学》2012年硕士论文

【摘要】：研究目的川崎病（Kawasaki disease，KD）是一种以全身中小动脉炎症为主要病理改变的疾病，KD并发冠脉扩张和/或动脉瘤形成，目前是小儿后天性心脏病的主要病因。早期诊断川崎病有利于改善预后，但目前尚缺乏敏感的诊断指标。分泌型磷脂酶A2（secretory phospholipase A2，sPLA2）作为一种新的炎症标志物，是预测临床冠状动脉事件发生的一个重要炎症因子。本研究通过观察sPLA2在川崎病发病急性期的变化，探讨它在川崎病早期诊断中的价值。方法本实验分为四组，24例确诊为KD的患儿作为KD组，18例确诊为呼吸道感染的患儿作为感染对照组，19例确诊为过敏性紫癜（Henoch-Schonlein purpu-ra,HSP）作为血管炎对照组，22例健康体检儿作为健康对照组。四组病人入院后即抽血测定sPLA2、C反应蛋白(C-reaetive protein，CRP)、血沉（ErythrocyteSedimentation Rate,ESR)、降钙素原（Procalcitonin，PCT）、血常规、肝肾功、心肌酶学等生化指标，同时拍胸部X光片，查心电图。对KD组患儿均行超声心动图检测。结果急性期KD组sPLA2明显升高，较其它组差异有统计学意义（P＜0.05）。冠脉病变组sPLA2的水平较无冠脉病变组的略有升高，但差异无统计学意义（P＞0.05）。典型川崎病组sPLA2水平与不完全川崎病组水平差异无统计学意义（P＞0.05）。急性期KD组sPLA2水平与CRP、ESR呈正相关（P＜0.05），而与PCT无相关性（P＞0.05）。以44.59ng/ml为截断值时，sPLA2诊断川崎病的灵敏度、特异度和曲线下面积分别95.8%、86.4%和0.859。 ESR以56.5mm/h为截断值时诊断川崎病的灵敏度、特异度和曲线下面积分别为83.3%、61.0%和0.807。 CRP以27.55mg/L为截断值时诊断川崎病的灵敏度、特异度和曲线下面积分别62.5%、83.1%和0.789。统计分析显示sPLA2在川崎病诊断效能上优于CRP和ESR。结论川崎病患儿血sPLA2在急性期明显升高，可用于KD患儿的早期诊断，且相对CRP、ESR，其对KD的早期诊断具有较高的敏感性和阴性预测值。
[Abstract]:Research purpose Kawasaki disease (Kawasaki disease) is a disease with systemic inflammation of middle and small arteries as the main pathological change. KD complicated by coronary artery dilatation and / or aneurysm formation is the main cause of acquired heart disease in children. The early diagnosis of Kawasaki disease is helpful to improve the prognosis, but there is still a lack of sensitive diagnostic indicators. As a new inflammatory marker, secretory phospholipase (A2(secretory phospholipase A _ 2) is an important inflammatory factor in predicting clinical coronary artery events. The purpose of this study was to investigate the value of sPLA2 in the early diagnosis of Kawasaki disease by observing its changes in the acute stage of Kawasaki disease. Method This experiment was divided into four groups: 24 children with KD as KD group, 18 children with respiratory tract infection as control group, 19 patients with Henoch-Schonlein purpu-rama HSPs as control group and 22 healthy children as healthy control group. After admission, the patients in the four groups were taken to determine the levels of serum sPLA2C-reactive protein, erythrocyte sedimentation rate, procalcitonine, blood routine, liver and kidney function, myocardial enzymes, and so on. At the same time, chest X-ray was taken and electrocardiogram was examined. All children with KD were examined by echocardiography. Result SPLA2 in KD group was significantly higher than that in other groups (P < 0.05). The level of sPLA2 in the coronary lesion group was slightly higher than that in the non-coronary lesion group, but the difference was not statistically significant (P > 0.05). There was no significant difference in sPLA2 level between typical Kawasaki disease group and incomplete Kawasaki disease group (P > 0.05). There was a positive correlation between sPLA2 level and PCT in KD group (P < 0.05), but no correlation with PCT (P > 0.05). The sensitivity, specificity and area under the curve of 44.59ng/ml for diagnosis of Kawasaki disease were 86.4% and 0.859%, respectively. The sensitivity, specificity and area under the curve of ESR for the diagnosis of Kawasaki disease were 81.0% and 0.807 when 56.5mm/h was used as truncation value. The sensitivity, specificity and area under the curve of CRP for the diagnosis of Kawasaki disease were 83.1% and 0.789%, respectively. Statistical analysis showed that sPLA2 was superior to CRP and ESR in the diagnosis of Kawasaki disease. Conclusion The serum sPLA2 of Kawasaki disease was significantly increased in the acute phase, which could be used in the early diagnosis of KD, and had a high sensitivity and negative predictive value to the early diagnosis of KD.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.4

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