探讨儿童川崎病急性期血清降钙素原(PCT)水平联合血清C反应蛋白(CRP)水平，对并发冠状动脉损害(CAL)的预测价值。

选取2015年11月1日至2016年12月31日，于重庆医科大学附属儿童医院确诊为川崎病后，接受规范化治疗，并且符合本研究纳入、排除标准的217例川崎病患儿为研究对象。采用回顾性分析方法，收集所有患儿的性别、年龄等一般临床资料，血清PCT、CRP水平检测结果，以及川崎病发病后30 d内的超声心动图检查结果。根据217例患儿川崎病急性期是否并发CAL，将其分别纳入CAL组(n＝72)和非CAL组(n＝145)。采用Mann-Whitney U检验，比较2组患儿的血清PCT、CRP水平。采用χ²检验，比较2组患儿的血清PCT、CRP阳性率。采用二元logistic回归分析方法，构建血清PCT与CRP水平预测川崎病患儿并发CAL的联合预测因子L。绘制联合预测因子L及血清PCT、CRP水平预测川崎病患儿并发CAL的受试者工作特征(ROC)曲线，计算ROC曲线下面积(ROC-AUC)，根据约登指数最大原则，确定联合预测因子L及血清PCR与CRP水平预测川崎病患儿并发CAL的最佳临界值，同时计算预测川崎病患儿并发CAL的敏感度、特异度。2组患儿性别构成比、年龄等一般临床资料比较，差异均无统计学意义(P>0.05)。

①CAL组与非CAL组患儿血清PCT水平中位数分别为1.16 μg/L与0.04 μg/L，血清CRP水平中位数分别为25.0 mg/L与16.4 mg/L，2组患儿血清PCT、CRP水平比较，差异均有统计学意义(Z＝－2.454，P＝0.046；Z＝－6.412，P<0.001)。2组患儿血清PCT、CRP阳性率分别比较，差异均无统计学意义(χ²＝1.222，P＝0.269；χ²＝0.665，P＝0.415)。②以川崎病患儿是否并发CAL作为二分类结局变量，血清CRP、PCT水平作为自变量，建立二元logistic回归方程的结果显示，血清CRP、PCT水平升高，均为川崎病患儿并发CAL的独立危险因素(OR＝1.077，95%CI：1.027～1.190，P<0.001；OR＝1.046，95%CI：1.015～1.078，P＝0.003)。构建的联测预测因子L的表达式为：L＝x₁＋0.608x₂，其中x₁、x₂分别是指血清CRP、PCT水平。③ROC曲线分析结果显示，联合预测因子L及血清PCT、CRP水平，对预测川崎病患儿并发CAL的ROC-AUC分别为0.773(95%CI：0.700～0.845，P<0.001)，0.560(95%CI：0.475～0.645，P＝0.148)和0.767(95%CI：0.695～0.839，P<0.001)。根据约登指数最大原则，联合预测因子L及血清PCT、CRP水平，预测川崎病患儿并发CAL的最佳临界值分别为23.068、2.32 μg/L和22.0 mg/L，此时其预测川崎病患儿并发CAL的敏感度分别为68.1%、30.6%、68.1%，特异度分别为83.4%、86.9%、80.7%。

监测儿童川崎病急性期血清PCT、CRP水平及其联合预测因子L值(L＝x₁＋0.608x₂，其中x₁、x₂分别是指血清CRP、PCT水平)，对儿童川崎病急性期并发CAL具有预测价值。

To explore the predictive values of serum procalcitonin (PCT) and C reactive protein (CRP) levels on coronary artery lesion (CAL) in acute phase of Kawasaki disease.

A total of 217 children with Kawasaki disease who hospitalized in Children′s Hospital of Chongqing Medical University from November 1, 2015 to December 31, 2016 were selected as research subjects. All the subjects have received standard Kawasaki disease treatments and all cases were in accord with the inclusion and exclusion criteria in this study. The gender, age, serum PCT and CRP levels, and echocardiographic findings within 30 d after the onset of Kawasake disease of all subjects were collected by retrospective method. According to children with acute Kawasaki disease complicated with CAL or not, they were divided into CAL group (n=22) and non-CAL group (n=29). Mann-Whitney U test was used to analyzed the differences of serum PCT and CRP levels between two groups. Chi-square test was used to compare the positive rates of serum PCT and CRP between two groups. Binary logistic regression analysis model was used to construct a new combined predictor L by serum PCT and CRP levels for predicting CAL in children with Kawasaki disease. And receiver operating characteristics (ROC) curves for new combined predictor L, serum PCR and CRP levels were built respectively, to evaluate the predictive values of combined predictor L and serum PCT, CRP levels on CAL in children with Kawasaki disease. The area under ROC curve (ROC-AUC) for combined predictor L and serum PCT, CRP levels in predicting CAL in children with Kawasaki disease all were calculated. The optimal cut-off point of combined predictor L and serum PCT, CRP levels predicting CAL in children with Kawasaki disease was obtained where the Youden index reached the maximum value. And diagnostic parameters such as sensitivity and specificity were also calculated for comparison.There were no statistically significant differences between two groups in the aspects of gender ratio, age, and so on (P>0.05).

①The medians of serum PCT level in CAL group and non-CAL group were 1.16 μg/L and 0.04 μg/L, respectively. The medians of serum CRP level in CAL group and non-CAL group were 25.0 mg/L and 16.4 mg/L, respectively. The levels of serum PCT and CRP in CAL group both were statistically higher than those in non-CAL group, and both the differences were statistically significant (Z=-2.454, P=0.046; Z=-6.412, P<0.001). There were no statistically significant differences in the positive rates of serum PCT and CRP between two groups (χ²=1.222, P=0.269; χ²=0.665, P=0.415). ②Binary logistic regression analysis model with complicated with CAL or not as a dichotomous outcome variable, and levels of serum CRP and PCT as independent variables showed that elevated levels of serum CRP and PCT were independent risk factors for children with Kawasaki disease complicated with CAL (OR=1.077, 95%CI: 1.027-1.190, P<0.001; OR=1.046, 95%CI: 1.015-1.078, P=0.003). The expression of combined predictor L was L=x₁+ 0.608x₂, in which x₁ and x₂ referred to the levels of serum CRP and PCT, respectively. ③ROC curve analysis indicated the values of ROC-AUC for combined predictor L, levels of serum PCT and CRP in predicting children with Kawasaki disease complicated with CAL were 0.773 (95%CI: 0.700-0.845, P<0.001), 0.560 (95%CI: 0.475-0.645, P=0.148), and 0.767 (95%CI: 0.695-0.839, P<0.001), respectively. The optimal cutoff values of combined predictor L, levels of serum PCT and CRP were 23.068, 2.32 μg/L, and 22.0 mg/L, respectively, and the sensitivities were 68.1%, 30.6% and 68.1%, respectively, the specialties were 83.4%, 86.9% and 80.7%, respectively.

Monitoring levels of serum PCT, CRP and combined predictor L (L=x₁+ 0.608x₂, x₁ and x₂ referred to levels of serum CRP and PCT, respectively) have predictive values to evaluate the occurrence of children with Kawasaki disease complicating CAL in acute phase.