Study On The Correlation Between Hcy、NLR、PLR And Coronary Artery Lesion In Kawasaki Disease

ObjectiveKawasaki disease(KD)is an acute,febrile vascular inflammatory disease involving multiple systems.It is a common self-limited vasculitis in childhood,and its etiology has not been fully elucidated.Cardiac vessels are most easily engaged in KD.Coronary artery lesion(CAL)and other complications may occur in children with KD,which seriously endanger the health of children.There are no specific biological indicators to predict the risk of CAL in KD children.In recent years,many scholars at home and abroad have reported the risk factors that may lead to the development of CAL in KD children,but some research conclusions are still controversial.Therefore,medical records of children with KD were collected in this paper to explore the risk factors causing CAL and analyze the predictive value of related indicators to CAL through a case-control study to guide clinical diagnosis and treatment and improve the prognosis of children.MethodsThis study collected the clinical data of 180 children with KD treated in the Department of Pediatrics of the First Affiliated Hospital of Henan University from January 2019 to October 2022 through an electronic medical record system.According to the occurrence of coronary artery damage,they were divided into 62 patients in the coronary artery damage group(CAL group)and 118 patients in the non-coronary artery damage group(NCAL group).The collected contents included gender,age,height,weight,strawberry tongue,perianal redness,and laboratory indicators of: ⑴ blood routine indexes: White blood cell(WBC),Hemoglobin(Hb),Platelet(PLT),Neutrophil-to-lymphocyte ratio(NLR),Platelet-to-lymphocyte ratio(PLR),⑵ biochemical indexes: Homocysteine(Hcy),Albumin(ALB),Prealbumin(PA),Aspartate aminotransferase(AST),Alanine aminotransferase(ALT),Cystatin C(Cys C),High-density lipoprotein cholesterol(HDL-C),Low-density lipoprotein cholesterol(LDL-C),⑶inflammatory response markers: C-reactive protein(CRP),Procalcitonin(PCT),Serum amyloid A(SAA),Erythrocyte sedimentation rate(ESR),Interleukin-6(IL-6),Tumor Necrosis Factor-alpha(TNF-α),⑷related indicators of cardiac function: Troponin I(c Tn I),Creatine kinase isoenzyme(CK-MB),N-terminal Prohormone of Brain Natriuretic Peptide(NT-pro BNP),⑸ coagulation function index: D-Dimer(D-D),echocardiography.SPSS26.0 software was used to conduct a univariate analysis of the two date groups,and the statistically significant indicators of univariate analysis were included in the binary Logistic regression analysis.Finally,ROC curves were drawn to evaluate the diagnostic effectiveness of related indicators on the occurrence of CAL.With(49)<0.05 difference is statistically significant.Results1.Add up to 180 KD children were enrolled in this study,including 115 males and 65 females,with a male-to-female ratio of about 1.8:1 and median age(month)is 28.0.The age of onset was <1 year in 22cases(12.22%),1 to 3 years in 92 cases(51.11%),3 to 5 years in 47 cases(26.11%)and ≥5 years in 19cases(10.56%).There were 62 sufferers in the CAL group and 118 sufferers in the NCAL group.There were 43 males(69%)and 19 females(31%)in the CAL group,while 72 males(61%)and 46 females(39%)in the NCAL group.The median age was 24.0 months the CAL group and 31.5 months in the NCAL group.The incidence of CAL in KD children under 1 year old was 50%,which was higher than that in other age groups.2.Among the 180 KD children,107(59.4%)had the strawberry tongue,and 62(34.4%)had the perianal redness.There were 37 cases(59.7%)of strawberry tongue in the CAL group and 70 cases(59.3%)of strawberry tongue in the NCAL group.Perianal redness occurred in 23 patients(37.1%)in the CAL group and 39 patients(33.1%)in the NCAL group.3.The levels of WBC,Hb,NLR,PLR,Hcy,NT-pro BNP and IL-6 in the CAL group were observably higher than those in the NCAL group.4.The results of single factor analysis: there were significant differences in age(month),WBC,Hb,NLR,PLR,Hcy,NT-pro BNP and IL-6 between the two groups((49)<0.05),but there were no significant differences in gender,strawberry tongue,perianal redness,PLT,ALB,PA,AST,Cys C,CRP and other indicators((49)>0.05).5.Multivariate regression analysis: The variables with statistically significant results of univariate analysis,including age(month),WBC,Hb,NLR,PLR,Hcy,NT-pro BNP and IL-6 were analyzed by binary Logistic regression analysis.The results showed that there were statistically remarkable differences in age(month),Hcy,NLR and PLR between the two groups((49)<0.05).These indicators are independent risk factors for CAL.By the ROC curve,the area under the curve of Hcy for predicting CAL was 0.732(95%CI0.652～0.811),the sensitivity was 67.7%,and the specificity was 72.9%.The AUC of NLR for predicting CAL was 0.779(95%CI 0.706～0.852),75.8% sensitivity and 73.7% specificity.The AUC of PLR for predicting CAL was 0.787(95%CI 0.718～0.857),the sensitivity was 74.2%,and the specificity was 72.0%.The AUC for predicting CAL was 0.879(95% CI 0.826-0.932)with a sensitivity of 79.0% and a specificity of 81.4% when all three were combined.Conclusions1.The incidence of KD was higher in boys than in girls,and the peak age of onset was 1 to 3 years old.The incidence of CAL was highest in children under one year old.2.WBC,Hb,IL-6,and NT-pro BNP may be the influencing factors of CAL.3.Young age and the increase of Hcy,NLR and PLR are independent risk factors for CAL in KD.The higher levels of Hcy,NLR and PLR have specific reference values for the clinical prediction of CAL in children with KD,and the combined prediction efficiency of the three indicators is better than that of a single index.