Comparison of N-terminal pro-brain natriuretic peptide and echocardiography in the early diagnosis of Kawasaki disease / 中华实用儿科临床杂志

ABSTRACT

Objective To compare the differences between roles of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and that of echocardiography in early diagnosis of Kawasaki disease (KD).Methods Medical records of patients with KD at the Department of Pediatrics,Fujian Provincial Hospital from January 2013 to December 2017 were collected retrospectively.The levels of NT-proBNP and the echocardiographic parameters on admission were compared between patients with varying days of fever by the Chi-squared test.Results A total of 154 patients with typical KD (TKD) were identified.Among them,104 cases had fever ≤7 days on admission,90 cases out of them with NT-proBNP≥300 ng/L,14 cases with coronary artery lesion detected by echocardiography,and 13 cases with positive findings in both NT-proBNP and echocardiography.For patients having ≤ 7 days of fever,the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination (x2 =74.05,P ＜ 0.05).Fortyfour cases had 8-11 days of fever,and among them 7 cases with NT-proBNP≥300 ng/L,8 cases with coronary artery lesion,3 cases with two indexes positive.For patients with 8-11 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).Among 6 total cases who had 12-21 days of fever,3 cases had coronary artery lesion,none with NT-proBNP ≥ 300 ng/L.For patients with 12-21 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).A total of 102 cases with incomplete KD (IKD) were enrolled,and among them of 69 cases had fever ≤7 days on admission,56 cases with NT-proBNP ≥ 300 ng/L,6 cases with coronary artery lesion,and 6 cases with positive findings in both indexes.For IKD patients with ≤ 7 days of fever,the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination (x2 =50.00,P ＜ 0.05).Twenty-nine cases had 8-11 days of fever,and among them 5 cases with NT-proBNP ≥ 300 ng/L,4 cases with coronary artery lesion.For IKD patients with 8-11 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).In cases with 12-21 days of fever,2 cases had coronary artery lesion,none with NT-proBNP ≥300 ng/L.Echocardiography revealed coronary artery lesions in 2 cases.For patients with 12-21 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).Conclusions Higher levels of NT-proBNP can be helpful for early diagnosis of KD in children,which is a better predictor than echocardiography.