川崎病冠脉病变患者血清穿孔素与和肽素检测的早期诊断及对清热益气活血法治疗预后的价值评价OA

Objective To investigate the value of serum perforin and copeptin detection in the early diagnosis of Kawasaki disease with coronary artery lesions(KD-CAL),and to analyze the value of the two indicators in evaluating the prognosis of patients treated with Qingre Yiqi Huoxue Therapy.Methods A total of 120 children with Kawasaki Disease(KD)admitted to Shaanxi Provincial People's Hospital from July 2021 to July 2023 were enrolled.Coronary artery diameter was measured by color Doppler echocardiography,and Z-scores were calculated.According to Z-score,the children with KD were divided into two groups:a KD group without coronary artery lesions(KD-nonCAL group,Z<2.5,n=60)and a KD group with coronary artery lesions(KD-CAL group,Z≥2.5,n=60).All children received the treatment regimen of Qingre Yiqi Huoxue Decoction combined with Western medicine(IVIG,aspirin,and dipyridamole).Efficacy evaluation was conducted after 4 weeks of treatment.Serum levels of perforin,copeptin,inflammatory indicators(IL-17A,TNF-α,PCT,CRP,ESR),and routine blood test indicators(WBC,PLT,HCT)were compared before treatment and 4 weeks after treatment.Results Compared with the KD-nonCAL group,the KD-CAL group showed significantly elevated levels of perforin,copeptin,inflammatory indexes(IL-17A,TNF-α,PCT,CRP,ESR),and routine blood test indexes(WBC,PLT),as well as significantly decreased HCT(t=-16.963 to 4.625,all P<0.05).Correlation analysis showed that Z-score was significantly positively correlated with the levels of perforin and copeptin(r=0.646 and 0.621,both P<0.05).The areas under the ROC curve(AUC)of perforin,copeptin,and their combination for diagnosing KD-CAL were 0.975,0.942,and 0.989,respectively.After 4 weeks of treatment with Qingre Yiqi Huoxue recipe combined with Western medicine,67 patients showed marked improvement,43 showed moderate improvement,and 10 showed no improvement,yielding a total response rate of 91.67％.Compared with the improved groups(marked+moderate),the non-improved group had significantly higher Z-scores,perforin,and copeptin levels(t=-12.990,-16.902,and-19.006,respectively,all P<0.05).Multiple linear regression analysis showed that the pre-to-post treatment differences in copeptin(B=0.043,Beta=0.300,t=3.013,P=0.003),perforin(B=0.004,Beta=0.282,t=2.779,P=0.006),and CRP(B=0.011,Beta=0.205,t=2.134,P=0.035)were all significantly positively correlated with the change in Z-score.Conclusions Perforin combined with copeptin has high value in the early diagnosis of KD-CAL,and copeptin,perforin,and CRP are important factors for predicting the improvement of coronary artery lesions in children with KD following Qingre Yiqi Huoxue treatment.