Abstract:

Objective　To investigate the relationship between myocardial function and serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), N-terminal pro B-type natriuretic peptide (NT-proBNP), procalcitonin (PCT), and coagulation indicators in children with Kawasaki disease (KD) complicated by mycoplasma pneumoniae (MP) infection. Methods　Eighty children with KD who were admitted to Yan'an University Affiliated Hospital from January 2020 to January 2024 were selected as the study subjects. The MP infection status of the children was detected, and they were grouped accordingly. 31 children with MP infection were included in the infection group, while the remaining 49 children were included in the non-infection group. There were 18 boys and 13 girls in the infection group, aged (3.16±1.22) years. There were 29 boys and 20 girls in the non-infection group, aged (3.72±1.45) years. The clinical data (age, maximum body temperature, duration of fever, conjunctival congestion, dry lips, strawberry tongue, oral mucosa congestion, trunk rashes, limb erythema, limb edema, skin peeling at fingertips, perianal peeling, cervical lymph node enlargement) and laboratory indicators (creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, aspartate aminotransferase, NT-proBNP, Lp-PLA2, PCT, prothrombin time, activated partial thromboplastin time, fibrinogen quantification, clotting time, antithrombin Ⅲ, D-dimer) were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Pearson correlation analysis was used to investigate the relationship between myocardial function and serum levels of Lp-PLA2, NT-proBNP, PCT, and coagulation indicators. Results　Comparison of the clinical data between the two groups showed no statistically significant differences (all P>0.05). The comparisons of the levels of creatine kinase, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, and aspartate aminotransferase between the two groups showed no statistically significant differences (all P>0.05); the level of creatine kinase isoenzyme in the infection group was higher than that in the non-infection group [(42.88±5.78) U/L vs. (30.88±7.12) U/L] (P<0.05). There was no statistically significant difference in the levels of serum NT-proBNP between the two groups (P>0.05); the levels of serum Lp-PLA2 and PCT in the infection group were higher than those in the non-infection group [(543.80±121.12) μg/L vs. (466.15±116.15) μg/L, (0.88±0.21) μg/L vs. (0.44±0.15) μg/L] (both P<0.05). There was no statistically significant difference in the comparisons of prothrombin time, activated partial thromboplastin time, fibrinogen quantification, clotting time, and antithrombin Ⅲ level between the two groups (all P>0.05); the D-dimer level in the infection group was higher than that in the non-infection group [(855.12±124.41) μg/L vs. (744.15±110.15) μg/L] (P<0.05). The Pearson correlation analysis showed that the level of creatine kinase isoenzyme was positively correlated with serum levels of Lp-PLA2, PCT, and D-dimer, the level of α-hydroxybutyrate dehydrogenase was positively correlated with the level of serum NT-proBNP, and the level of aspartate aminotransferase was positively correlated with the level of serum PCT (all P<0.05). Conclusion　Children with KD combined with MP infection have more severe impairment of myocardial function, and it also affects the inflammatory response and coagulation function of the children. Specifically, the levels of creatine kinase isoenzyme, serum Lp-PLA2, PCT, and D-dimer increase. There is a positive correlation between myocardial enzymes and inflammatory and coagulation function indicators.

Key words: Mycoplasma pneumoniae,  , Kawasaki disease,  , Myocardial function,  , Lipoprotein-associated phospholipase A2,  , N-terminal pro B-type natriuretic peptide,  , Procalcitonin,  , Coagulation indicators

摘要：

目的　探究川崎病（KD）合并肺炎支原体（MP）感染患儿心肌功能与血清脂蛋白磷脂酶A2（Lp-PLA2）、N-末端脑利钠肽原（NT-proBNP）、降钙素原（PCT）水平及凝血指标的关系。方法　选取2020年1月至2024年1月延安大学附属医院收治的80例KD患儿作为研究对象。检测患儿MP感染情况，并以此进行分组，31例合并MP感染患儿纳入合并感染组，剩余49例患儿纳入未合并组。合并感染组男18例，女13例；年龄（3.16±1.22）岁。未合并组男29例，女20例；年龄（3.72±1.45）岁。比较两组临床资料（年龄、最高体温、发热持续时间、球结膜充血、口唇干裂、杨梅舌、口腔黏膜充血、躯干皮疹、四肢红斑、四肢水肿、指端脱皮、肛周脱皮、颈部淋巴结肿大）和实验室指标（肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶、天门冬氨酸氨基转移酶、NT-proBNP、Lp-PLA2、PCT、凝血酶原时间、活化部分凝血酶原时间、纤维蛋白原定量、凝血时间、抗凝血酶Ⅲ、D-二聚体）。采用独立样本t检验和χ²检验进行统计学分析。采用Pearson相关性分析心肌功能与血清Lp-PLA2、NT-proBNP、PCT水平及凝血指标的关系。结果　两组临床资料比较，差异均无统计学意义（均P>0.05）。两组肌酸激酶、乳酸脱氢酶、α-羟丁酸脱氢酶、天门冬氨酸氨基转移酶水平比较，差异均无统计学意义（均P>0.05）；合并感染组肌酸激酶同工酶水平高于未合并组［（42.88±5.78）U/L比（30.88±7.12）U/L］（P<0.05）。两组血清NT-proBNP水平比较，差异无统计学意义（P>0.05）；合并感染组血清Lp-PLA2、PCT水平均高于未合并组［（543.80±121.12）μg/L比（466.15±116.15）μg/L、（0.88±0.21）μg/L比（0.44±0.15）μg/L］（均P<0.05）。两组凝血酶原时间、活化部分凝血酶原时间、纤维蛋白原定量、凝血时间、抗凝血酶Ⅲ水平比较，差异均无统计学意义（均P>0.05）；合并感染组D-二聚体水平高于未合并组［（855.12±124.41）μg/L比（744.15±110.15）μg/L］（P<0.05）。Pearson相关性分析显示，肌酸激酶同工酶水平与血清Lp-PLA2、PCT、D-二聚体水平呈正相关，α-烃丁酸脱氢酶水平与血清NT-proBNP水平呈正相关，天门冬氨酸氨基转移酶水平与血清PCT水平呈正相关（均P<0.05）。结论　KD合并MP感染患儿心肌功能受损较严重，且影响患儿炎症反应及凝血功能，具体表现为肌酸激酶同工酶、血清Lp-PLA2、PCT、D-二聚体水平升高，心肌酶与炎症、凝血功能指标存在正相关关系。

关键词: 肺炎支原体, 川崎病, 心肌功能, 脂蛋白磷脂酶A2, N-末端脑利钠肽原, 降钙素原, 凝血指标