血清ANGPTL8、ITLNG1对川崎病患儿冠状动脉损伤的预测价值

Predictive value of serum ANGPTL8 and ITLNG1 for coronary artery injury in children with Kawasaki disease

摘要

目的 探讨血清血管生成素样蛋白8(ANGPTL8)、凝集蛋白G1(ITLNG1)对川崎病(KD)患儿冠状动脉损伤的预测价值。方法 选取2020年5月至2023年5月在本院就诊的108例KD患儿作为研究组,根据是否发生冠状动脉损伤分为冠状动脉损伤组(n=37)与无冠状动脉损伤组(n=71);另选取同期体检健康儿童72例作为对照组.采用双抗体夹心酶联免疫吸附法检测所有受试者血清炎症相关指标及ANGPTL8、ITLNG1水平;Pearson法分析冠状动脉损伤KD患儿血清ANGPTL8、ITLNG1水平与炎症指标的相关性;评估血清ANGPTL8、ITLNG1水平对KD患儿冠状动脉损伤的预测价值。结果 冠状动脉损伤组KD患儿PLT、CRP、IL-6和TNF-α水平明显高于无冠状动脉损伤组及对照组(F/χ²值分别为67.198、75.056、71.876及94.158,P<0.05);与对照组相比,研究组KD患儿血清ANGPTL8水平明显升高(t=17.490,P<0.05),ITLNG1水平明显降低(t=13.162,P<0.05);与无冠状动脉损伤组相比,冠状动脉损伤组患儿血清ANGPTL8水平明显升高(t=7.454,P<0.05),ITLNG1水平明显降低(t=7.631,P<0.05).Pearson相关分析结果显示,冠状动脉损伤KD患儿血清ANGPTL8水平与PLT及CRP、IL-6、TNF-α水平均呈正相关(r=0.514、0.638、0.484、0.674,P<0.05),ITLNG1水平与PLT及CRP、IL-6、TNF-α水平均呈负相关(r=-0.603、-0.659、-0.439、-0.646,P<0.05).ROC曲线分析结果显示,血清ANGPTL8、ITLNG1联合预测KD患儿冠状动脉损伤的曲线下面积(AUC)为0.950,敏感度为89.19%,特异度为85.91%.多因素Logistic回归分析结果显示,PLT、CRP、IL-6、TNF-α、ANGPTL8水平升高是KD患儿冠状动脉损伤的独立危险因素,ITLNG1水平升高是KD患儿冠状动脉损伤的保护因素.其OR值及95%CI分别为1.623(1.088~2.421)、1.722(1.266~2.342)、1.413(1.035~1.930)、1.725(1.210~2.460)、1.534(1.114~2.111)和0.685(0.485~0.967)。结论 KD冠状动脉损伤患儿血清ANGPTL8水平明显升高,ITLNG1水平明显降低,且ANGPTL8水平升高、ITLNG1水平降低为KD患儿冠状动脉损伤的独立危险因素,联合检测二者血清水平对KD患儿冠状动脉损伤有较高的预测价值.

Abstract

Objective To explore the predictive value of serum angiopoietin-like protein 8 (ANGPTL8) and intelectin-1 (ITLNG1) in coronary artery injury in children with Kawasaki disease (KD). Methods A total of 108 children with KD who were admitted to our hospital from May 2020 to May 2023 were regarded as the study group, they were divided into coronary artery injury group (n=37) and non-coronary artery injury group (n=71) according to the occurrence of coronary artery injury; another 72 healthy children who underwent physical examination were regarded as the control group. Double-antibody sandwich enzyme-linked immunosorbent assay was applied to detect serum inflammation related markers and levels of ANGPTL8 and ITLNG1 in all subjects. Pearson's method was applied to analyze the correlation between serum levels of ANGPTL8, ITLNG1 and inflammatory markers in KD patients with coronary artery injury. The predictive value of serum ANGPTL8 and ITLNG1 levels for coronary artery injury in children with KD was evaluated. Results In the coronary artery injury group, KD children had significantly higher levels of platelet (PLT), C-reaction protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) compared to the non-coronary artery injury group (F/χ²=67.198, 75.056, 71.876 and 94.158, respectively, all P<0.05); compared with the control group, KD children in the study group showed a significant increase in serum ANGPTL8 levels (t=17.490, P<0.05), and a significant decrease in ITLNG1 levels (t=13.162, P<0.05); compared with the non-coronary artery injury group, KD children in the coronary artery injury group exhibited a significant increase in serum ANGPTL8 levels (t=7.454, P<0.05) and a significant decrease in ITLNG1 levels (t=7.631, P<0.05). The results of pearson correlation analysis showed that in KD children with coronary artery injury, serum levels of ANGPTL8 were positively correlated with PLT, CRP, IL-6 and TNF-α levels (r=0.514, 0.638, 0.484 and 0.674, respectively, P<0.05), while the ITLNG1 levels were negatively correlated with PLT, CRP, IL-6 and TNF-α levels (r=-0.603, -0.659, -0.439 and -0.646, respectively, P<0.05). The results of receiver operating characteristic (ROC) curve analysis showed that the combined prediction of serum ANGPTL8 and ITLNG1 for coronary artery injury in KD children had an area under the curve (AUC) of 0.950, with a sensitivity of 89.19% and a specificity of 85.91%. The results of multivariate logistic regression analysis showed that elevated levels of PLT, CRP, IL-6, TNF-α and ANGPTL8 were independent risk factors for coronary artery injury in children with KD, while an elevated level of ITLNG1 was a protective factor for coronary artery injury in children with KD. The OR values and 95% CI were as follows: 1.623 (1.088-2.421) for PLT, 1.722 (1.266-2.342) for CRP, 1.413 (1.035-1.930) for IL-6, 1.725 (1.210-2.460) for TNF-α, 1.534 (1.114-2.111) for ANGPTL8, and 0.685 (0.485-0.967) for ITLNG1. Conclusion The serum levels of ANGPTL8 in KD children with coronary artery injury are obviously increased, while the level of ITLNG1 is obviously decreased. The independent risk factors for coronary artery injury in KD children include elevated levels of ANGPTL8 and decreased levels of ITLNG1. The combined assessment of their serum levels holds a high predictive value for coronary artery injury in children with KD.

关键词

血管生成素样蛋白8 / 凝集蛋白G1 / 川崎病 / 冠状动脉损伤 / 预测价值

Key words

angiopoietin-like protein 8 / intelectin-1 / Kawasaki disease / coronary artery injury / predictive value

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基金资助

盐城市科学技术局2022年度市重点研发计划项目(YCBE202226)