The Value Of MMP-9 And Inflammatory Indicators In Predicting Kawasaki Disease Combined With Coronary Artery Injury

Objective:To completely reveal the core risk factors for Kawasaki disease(KD)combined with coronary artery injury(CAL),we analyzed the clinical case data and the levels of various inflammatory indicators as well as serum IL-6 and matrix metalloproteinase-9(MMP-9)of 128 child patients with KD;To identify high-risk child patients with KD combined with CAL and provide guidance for clinicians in the early prevention and cure of CAL we explored the value of the combination of MMP-9 and various inflammatory indicators in predicting KD combined with CAL.Methods:The clinical case data of 128 child patients with KD who were admitted into Second Hospital of the Lanzhou University from 2015 to 2018 were obtained.The serum levels of MMP-9 and IL-6 of these patients were determined by enzyme-linked immunosorbent assay(ELISA).According to clinical manifestations and CAL they were divided into four groups: complete KD(CKD),incomplete KD(IKD),KD combined with CAL,and KD not combined with CAL.The biochemical indicators of each group(WBC,NE%,PLT,ESR,CRP,ALB,RBC,HGB,MMP-9 and IL-6)were statistically analyzed,the epidemiological characteristics were summarized,and the core risk factors for CAL were analyzed.By using ROC curve,WBC,NE%,PLT,ESR,CRP,ALB,RBC,HGB,MMP-9 and MMP-9 combined with PLT,ESR and CRP were analyzed to obtain the sensitivities and specificities of indicators predicting whether children with KD had concurrent CAL,and their areas under the curve were compared to obtain and the value of each index in predicating KD complicated with CAL.Results:1.The numbers of male patients in every age groups were higher than those of female patients of KD.The mean age was(2.7±2.03)years old and the male/female ratio was 2.12:1.December was the month with the highest incidence,followed by June and September,so there were more patients in summer and winter.2.The duration of fever in IKD group was longer than that of CKD group,showing a statistically significant difference(P<0.05).The occurrence rates of skin rash,altered oral mucous membrane,conjunctival congestion,Bayberry tongue,cervical lymph node enlargement,limb changes and perianal changes in CKD group were remarkably higher than those in IKD group,and the differences were statistically significant(P<0.05).The WBC and NE% of CKD group were higher than those of IKD group,showing statistically significant differences(P<0.05).The people of CAL in IKD group was obviously higher than that in CKD group,showing a statistically significant difference(P<0.05).3.There were 75 patients in CAL group,and the male/female ratio was 3.41:1.CAL group and NCAL group showed a statistically significant difference in sex(P<0.05),and CAL was more likely to occur in boys with KD.All the patients were divided into three age groups: 0~ year old,1~ years old and 3~ years old and compared,showing statistically significant differences compared with other age groups(P<0.05),and CAL was more likely to occur in KD children aged less than 12 months.Various laboratory indicators of CAL group and NCAL group were statistically analyzed.The results showed that PLT,CRP and ESR were obviously elevated and ALB was decreased,and the two groups had statistically significant differences in these indicators(P<0.05).Statistically significant indicators in univariate analysis,including sex,age,PLT,ESR,CRP and ALB,were subjected to multivariate Logistic regression analysis,and the result suggested that the ESR、PLT、CRP and MMP-9 elevation were the independent risk factors for CAL in KD patients.4.The serum level of MMP-9 in CKD group was obviously elevated than that in KID group,showing a statistically significant difference(P<0.05).The serum level of MMP-9 in CAL group was significantly higher than that in NCAL group(P<0.05).Spearman rank correlation analysis found that IL-6 had a linear correlation with NE%,ESR and CRP respectively,MMP-9 had a linear correlation with ESR and CRP respectively,and IL-6 had a linear correlation with MMP-9.5.MMP-9,PLT,ESR,CRP and MMP-9 combined with PLT,ESR and CRP were effective predicting indicators for distinguishing CAL from NCAL,showing statistically significant differences(P<0.05).Compared with the AUC of each single indicator,MMP-9 combined with PLT,ESR and CRP had the highest efficacy in the predicting of CAL and performed better than each single indicator,showing statistically significant differences(P<0.05).Conclusions:1.The KD often occurs in boys 1 to 3 years old,mostly in summer and winter.They have different manifestations,and various inflammatory indexes are increased.2.IKD’s clinical manifestations are complicated and concealed.CAL is more likely to occur in patients with IKD.3.The ESR、PLT、CRP and MMP-9 elevation are the independent risk factors for KD combined with CAL.4.The serum levels of MMP-9 in CKD group and CAL group are increased significantly,indicating that MMP-9 can be used as an indicator for the differential diagnosis of CKD and IKD and an inflammatory predictive indicator for the early diagnosis of CAL.5.The joint detection of MMP-9,PLT,ERR and CRP is highly effective in predicting KD combined with CAL.