目的/背景川崎病是一种主要影响幼儿的急性炎症。会导致冠状动脉异常,这会使预后恶化。冠心病的早期诊断对于有效治疗和预后评估至关重要。探讨超声检查特点的临床意义,外周血红细胞分布宽度,和N末端脑钠肽前体水平的变化对早期发现川崎病患儿冠状动脉异常具有重要意义。方法采用病例对照研究方法。选取2020年1月至2023年12月在我院确诊的85例川崎病患者作为川崎病组。选取同期在儿童保健科体检的健康儿童100例作为对照组。心脏超声指标,红细胞沉降率,C反应蛋白,白细胞,中性粒细胞百分比,血小板计数,D-二聚体,红细胞分布宽度,比较两组患者的N末端脑钠肽前体水平。根据川崎病患者是否发生冠状动脉病变,将川崎病组进一步分为冠状动脉病变组和非冠状动脉病变组。比较上述指标的差异。结果左冠状动脉主干,左前降支,川崎病组右冠状动脉Z评分均高于对照组(p<0.05)。川崎病组左室射血分数与对照组比较差异无统计学意义(p>0.05)。红细胞沉降率,C反应蛋白,中性粒细胞百分比,血小板计数,D-二聚体,红细胞分布宽度,川崎病组的N末端脑钠肽前体均高于对照组(p<0.05)。左冠状动脉主干,左前降支,有冠状动脉病变的川崎病患者的右冠状动脉Z评分均高于无冠状动脉病变的川崎病患者(p<0.05)。有冠状动脉病变的川崎病患者左心室射血分数低于无冠状动脉病变的川崎病患者(p<0.05)。红细胞沉降率,C反应蛋白,白细胞,中性粒细胞百分比,血小板计数,D-二聚体,红细胞分布宽度,有冠状动脉病变的川崎病患者的N末端脑钠肽前体均高于无冠状动脉病变的川崎病患者,差异均有统计学意义(p<0.05)。治疗后,左冠状动脉主干,左前降支,川崎病冠状动脉病变患者的右冠状动脉Z评分明显下降(p<0.05),左心室射血分数显著升高(p<0.05)。红细胞沉降率,C反应蛋白,白细胞,中性粒细胞百分比,血小板计数,D-二聚体,红细胞分布宽度,川崎病伴或不伴冠状动脉病变患者的N末端脑钠肽前体治疗后较同组治疗前明显下降(p<0.05)。结论川崎病冠状动脉病变患者冠状动脉血管直径明显增大,以及升高的红细胞分布宽度和N末端脑钠肽前体浓度。超声联合红细胞分布宽度和N末端脑钠肽前体检查可辅助判断川崎病患者是否有冠状动脉病变,评估临床治疗效果。
Aims/Background Kawasaki disease is an acute inflammatory condition primarily affecting the young children. It can lead to coronary artery abnormalities, which can worsen the prognosis. Early diagnosis of coronary disease is crucial for the effective treatment and the prognosis evaluation. To explore the clinical significance of ultrasound examination characteristics, peripheral blood red cell distribution width, and changes in N-terminal pro-brain natriuretic peptide levels for the early detect coronary artery abnormality in children with Kawasaki disease. Methods The case-control study was conducted. 85 Kawasaki disease patients diagnosed in our hospital from January 2020 to December 2023 were selected as the Kawasaki disease group. 100 healthy children who received physical examination in the Department of Child Healthcare during the same period were selected as control group. The cardiac ultrasound indicators, erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, N-terminal pro-brain natriuretic peptide of two groups were compared. The Kawasaki disease group was further divided into the coronary artery lesion group and the non-coronary artery lesion group based on whether coronary artery lesions occurred in the Kawasaki disease patients. The differences of above indicators were compared. Results The left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of the Kawasaki disease group were all higher than those of the control group (p < 0.05). There was no significant difference in left ventricular ejection fraction between Kawasaki disease group and control group (p > 0.05). The erythrocyte sedimentation rate, C-reactive protein, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease group were all higher than those of control group (p < 0.05). The left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of Kawasaki disease patients with coronary artery lesions were all higher than those of Kawasaki disease patients without coronary artery lesions (p < 0.05). The left ventricular ejection fraction of Kawasaki disease patients with coronary artery lesions was lower than that of Kawasaki disease patients without coronary artery lesions (p < 0.05). The erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease patients with coronary artery lesions were all higher than those of Kawasaki disease patients without coronary artery lesions, and the differences were statistically significant (p < 0.05). After treatment, the left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of Kawasaki disease patients with coronary artery lesions significantly decreased (p < 0.05), and the left ventricular ejection fraction significantly increased (p < 0.05). The erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease patients with or without coronary artery lesions significantly decreased after treatment compared with before treatment in the same group (p < 0.05). Conclusion Kawasaki disease patients with coronary artery lesions exhibit significantly increased coronary artery vessel diameter, as well as elevated red cell distribution width and N-terminal pro-brain natriuretic peptide concentration. The combined use of ultrasound combined with red cell distribution width and N-terminal pro-brain natriuretic peptide examination can assist in determining whether Kawasaki disease patients have coronary artery lesions and assessing the clinical treatment effect.