本文選題：川崎病 + 早期診斷��； 參考：《福建醫(yī)科大學(xué)》2012年碩士論文

【摘要】：研究目的 川崎�。↘awasaki disease，KD）是一種以全身中小動脈炎癥為主要病理改變的疾病，KD并發(fā)冠脈擴(kuò)張和/或動脈瘤形成，目前是小兒后天性心臟病的主要病因。早期診斷川崎病有利于改善預(yù)后，但目前尚缺乏敏感的診斷指標(biāo)。分泌型磷脂酶A2（secretory phospholipase A2，sPLA2）作為一種新的炎癥標(biāo)志物，是預(yù)測臨床冠狀動脈事件發(fā)生的一個(gè)重要炎癥因子。本研究通過觀察sPLA2在川崎病發(fā)病急性期的變化，探討它在川崎病早期診斷中的價(jià)值。 方法 本實(shí)驗(yàn)分為四組，24例確診為KD的患兒作為KD組，18例確診為呼吸道感染的患兒作為感染對照組，19例確診為過敏性紫癜（Henoch-Schonlein purpu-ra,HSP）作為血管炎對照組，22例健康體檢兒作為健康對照組。四組病人入院后即抽血測定sPLA2、C反應(yīng)蛋白(C-reaetive protein，CRP)、血沉（ErythrocyteSedimentation Rate,ESR)、降鈣素原（Procalcitonin，PCT）、血常規(guī)、肝腎功、心肌酶學(xué)等生化指標(biāo)，同時(shí)拍胸部X光片，查心電圖。對KD組患兒均行超聲心動圖檢測。 結(jié)果 急性期KD組sPLA2明顯升高，較其它組差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。冠脈病變組sPLA2的水平較無冠脈病變組的略有升高，但差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。典型川崎病組sPLA2水平與不完全川崎病組水平差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。急性期KD組sPLA2水平與CRP、ESR呈正相關(guān)（P＜0.05），而與PCT無相關(guān)性（P＞0.05）。以44.59ng/ml為截?cái)嘀禃r(shí)，sPLA2診斷川崎病的靈敏度、特異度和曲線下面積分別95.8%、86.4%和0.859。 ESR以56.5mm/h為截?cái)嘀禃r(shí)診斷川崎病的靈敏度、特異度和曲線下面積分別為83.3%、61.0%和0.807。 CRP以27.55mg/L為截?cái)嘀禃r(shí)診斷川崎病的靈敏度、特異度和曲線下面積分別62.5%、83.1%和0.789。統(tǒng)計(jì)分析顯示sPLA2在川崎病診斷效能上優(yōu)于CRP和ESR。 結(jié)論 川崎病患兒血sPLA2在急性期明顯升高，可用于KD患兒的早期診斷，且相對CRP、ESR，其對KD的早期診斷具有較高的敏感性和陰性預(yù)測值。
[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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.4

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