基質(zhì)金屬蛋白酶-9在川崎病早期診斷中的價(jià)值;白海濤
發(fā)布時(shí)間：2018-07-26 11:48
【摘要】：研究背景 川崎病(Kawasaki Disease, KD)并發(fā)冠狀動(dòng)脈損傷是導(dǎo)致兒童后天性心臟病最主要的疾病，也是常見的血管炎癥性疾病。早期診斷早期治療，可以減少冠狀動(dòng)脈損傷的發(fā)生率。目前川崎病的診斷標(biāo)準(zhǔn)是以臨床表現(xiàn)為主的排除性診斷，缺乏客觀性診斷標(biāo)準(zhǔn)，，尤其是不完全川崎�。╥ncomplete Kawasaki disease，iKD）患兒早期診斷相對(duì)困難，尋找可靠的血清學(xué)輔助診斷指標(biāo)是目前研究的熱點(diǎn)�；|(zhì)金屬蛋白酶-9(Matrix Metalloproteinase-9，MMP-9)參與了血管壁細(xì)胞外基質(zhì)（Extracellular matrix，ECM）的降解過程，在血管炎癥的過程中發(fā)揮著重要的作用。研究基質(zhì)金屬酶-9和川崎病之間的關(guān)系，可能為川崎病患兒的早期診斷帶來幫助。 目的 通過觀察川崎病發(fā)病早期的MMP-9血漿水平，了解它與川崎病之間的相關(guān)性，初步探討它在川崎病診斷中的價(jià)值。 方法 對(duì)早期疑似川崎病的兒童入院后常規(guī)抽血，采用酶聯(lián)免疫吸附法測(cè)量血漿MMP-9的水平，回顧性分析MMP-9在確診川崎病組病例與過敏性紫癜組、發(fā)熱組、健康對(duì)照組水平差異，同時(shí)分析在典型川崎病組與不完全川崎病組、冠狀動(dòng)脈擴(kuò)張組與無冠狀動(dòng)脈擴(kuò)張組水平差異；分析MMP-9與臨床常用炎癥反應(yīng)指標(biāo)血清降鈣素原（Procalcitonin，PCT）、血沉（Erythrocyte Sedimentation Rate，ESR）、C反應(yīng)蛋白（C-reactive proteinCRP）的相關(guān)性；以受試者工作曲線（ReceiverOperator Characteristive Curve，ROC曲線）分析MMP-9、ESR、CRP作為診斷是否川崎病的截?cái)嘀担╟utoff值）和相應(yīng)的靈敏度和特異度，并比較曲線下面積，比較各指標(biāo)的診斷優(yōu)勢(shì)。 結(jié)果 血漿MMP-9水平在川崎病早期明顯升高，顯著高于HSP組、感染組和健康對(duì)照組的水平，（ｐ＜0.05)。MMP-9的水平在典型和不完全川崎病之間沒有顯著性差異，而在冠狀動(dòng)脈擴(kuò)張組的均值高于無冠狀動(dòng)脈擴(kuò)張組，但差異沒有顯著性。ROC曲線結(jié)果顯示MMP-9血漿值為90.23ng/mL的截?cái)嘀禃r(shí)檢測(cè)的靈敏度、特異度和曲線下面積,分別為83.3%、86.4%和0.904。以56.5mm/h為截?cái)嘀禃r(shí)ESR的靈敏度、特異度和曲線下面積，分別為95.8%、66.1%和0.807。以27.55mg/L為截?cái)嘀禃r(shí)CRP的靈敏度、特異度和曲線下面積,分別為83.3%、74.6%和0.789。統(tǒng)計(jì)分析顯示MMP－9在川崎病診斷效能上優(yōu)于CRP和ESR。 結(jié)論 MMP-9在川崎病早期兒童中血漿水平明顯升高，在截?cái)嘀禐?0.23ng/mL診斷川崎病靈敏度和特異度較高，可作為川崎病兒童的早期輔助血清學(xué)檢查的生物標(biāo)記物。
[Abstract]:Background Kawasaki disease (Kawasaki disease) complicated with coronary artery injury (Kawasaki Disease, KD) is the leading cause of acquired heart disease in children and a common vascular inflammatory disease. Early diagnosis and early treatment can reduce the incidence of coronary artery injury. At present, the diagnostic criteria of Kawasaki disease are exclusion diagnosis, which is based on clinical manifestation, but lack of objective diagnostic criteria, especially the early diagnosis of incomplete Kawasaki disease (incomplete Kawasaki disease) is relatively difficult. It is a hot point to search for reliable serological diagnostic indexes. Matrix metalloproteinase-9 (MMP-9) is involved in the degradation of Extracellular matrix and plays an important role in the process of vascular inflammation. The study of the relationship between matrix metallozyme-9 and Kawasaki disease may be helpful for the early diagnosis of Kawasaki disease. Objective to investigate the relationship between MMP-9 plasma level and Kawasaki disease in the early stage of Kawasaki disease (Kawasaki disease) and to explore its value in the diagnosis of Kawasaki disease. Methods Plasma MMP-9 levels were measured by enzyme linked immunosorbent assay (Elisa) in early suspected Kawasaki disease (Kawasaki disease) children after admission. MMP-9 was analyzed retrospectively in Kawasaki disease group, Henoch-Schonlein purpura group and fever group. At the same time, the levels of coronary artery dilatation group and non-coronary artery dilatation group were compared between the typical Kawasaki disease group and the incomplete Kawasaki disease group. To analyze the correlation between MMP-9 and serum procalcitonin (PC), erythrocyte sedimentation rate (ESR), (Erythrocyte Sedimentation (Erythrocyte Sedimentation) C reactive protein (C-reactive proteinCRP). The sensitivity and specificity of MMP-9 ESR-CRP in Kawasaki disease (Kawasaki disease) were analyzed by using the (ReceiverOperator Characteristive curve (ROC curve). The area under the curve was compared and the diagnostic advantages of each index were compared. Results the plasma MMP-9 level was significantly higher in the early stage of Kawasaki disease than in the HSP group. There was no significant difference in the level of MMP-9 between typical and incomplete Kawasaki disease. However, the mean value of MMP-9 in the coronary artery dilatation group was higher than that in the non-coronary artery dilatation group, but there was no significant difference in .ROC curve. The sensitivity, specificity and area under the curve were 83.3% and 0.904%, respectively, when the plasma value of MMP-9 was truncated by 90.23ng/mL. The sensitivity, specificity and area under the curve of 56.5mm/h were 95.8% and 0.807%, respectively. The sensitivity, specificity and area under the curve of 27.55mg/L were 74.6% and 0.789%, respectively. Statistical analysis showed that MMP-9 was superior to CRP and ESR in the diagnosis of Kawasaki disease. Conclusion the plasma level of MMP-9 in children with Kawasaki disease was significantly higher than that in children with Kawasaki disease, and the sensitivity and specificity of 90.23ng/mL in the diagnosis of Kawasaki disease were higher than those in the truncated value, which could be used as a biomarker for early serological examination in children with Kawasaki disease.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.4
[Abstract]:Background Kawasaki disease (Kawasaki disease) complicated with coronary artery injury (Kawasaki Disease, KD) is the leading cause of acquired heart disease in children and a common vascular inflammatory disease. Early diagnosis and early treatment can reduce the incidence of coronary artery injury. At present, the diagnostic criteria of Kawasaki disease are exclusion diagnosis, which is based on clinical manifestation, but lack of objective diagnostic criteria, especially the early diagnosis of incomplete Kawasaki disease (incomplete Kawasaki disease) is relatively difficult. It is a hot point to search for reliable serological diagnostic indexes. Matrix metalloproteinase-9 (MMP-9) is involved in the degradation of Extracellular matrix and plays an important role in the process of vascular inflammation. The study of the relationship between matrix metallozyme-9 and Kawasaki disease may be helpful for the early diagnosis of Kawasaki disease. Objective to investigate the relationship between MMP-9 plasma level and Kawasaki disease in the early stage of Kawasaki disease (Kawasaki disease) and to explore its value in the diagnosis of Kawasaki disease. Methods Plasma MMP-9 levels were measured by enzyme linked immunosorbent assay (Elisa) in early suspected Kawasaki disease (Kawasaki disease) children after admission. MMP-9 was analyzed retrospectively in Kawasaki disease group, Henoch-Schonlein purpura group and fever group. At the same time, the levels of coronary artery dilatation group and non-coronary artery dilatation group were compared between the typical Kawasaki disease group and the incomplete Kawasaki disease group. To analyze the correlation between MMP-9 and serum procalcitonin (PC), erythrocyte sedimentation rate (ESR), (Erythrocyte Sedimentation (Erythrocyte Sedimentation) C reactive protein (C-reactive proteinCRP). The sensitivity and specificity of MMP-9 ESR-CRP in Kawasaki disease (Kawasaki disease) were analyzed by using the (ReceiverOperator Characteristive curve (ROC curve). The area under the curve was compared and the diagnostic advantages of each index were compared. Results the plasma MMP-9 level was significantly higher in the early stage of Kawasaki disease than in the HSP group. There was no significant difference in the level of MMP-9 between typical and incomplete Kawasaki disease. However, the mean value of MMP-9 in the coronary artery dilatation group was higher than that in the non-coronary artery dilatation group, but there was no significant difference in .ROC curve. The sensitivity, specificity and area under the curve were 83.3% and 0.904%, respectively, when the plasma value of MMP-9 was truncated by 90.23ng/mL. The sensitivity, specificity and area under the curve of 56.5mm/h were 95.8% and 0.807%, respectively. The sensitivity, specificity and area under the curve of 27.55mg/L were 74.6% and 0.789%, respectively. Statistical analysis showed that MMP-9 was superior to CRP and ESR in the diagnosis of Kawasaki disease. Conclusion the plasma level of MMP-9 in children with Kawasaki disease was significantly higher than that in children with Kawasaki disease, and the sensitivity and specificity of 90.23ng/mL in the diagnosis of Kawasaki disease were higher than those in the truncated value, which could be used as a biomarker for early serological examination in children with Kawasaki disease.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.4
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