2021 年第 2 期 第 16 卷

血清成纤维细胞生长因子23和Klotho对川崎病合并冠状动脉损伤的诊断价值

Diagnostic value of serum fibroblast growth factor 23 and Klotho in Kawasaki disease complicated with coronary artery injury

作者：丁蓉1郝晶2张振兴1陆超1

英文作者：Ding Rong1 Hao Jing2 Zhang Zhenxing1 Lu Chao1

单位：1南京医科大学第一附属医院儿科210036；2南京市儿童医院重症医学科210008

英文单位：1Department of Paediatrics the First Affiliated Hospital with Nanjing Medical University Nanjing 210036 China; 2Department of Critical Care Medicine Nanjing Children′s Hospital Nanjing 210008 China

关键词：川崎病；成纤维细胞生长因子23；Klotho；碱性磷酸酶

英文关键词：Kawasakidisease;Fibroblastgrowthfactor23;Klotho;Alkalinephosphatase

• 摘要：

• 目的 探讨川崎病合并冠状动脉损伤（CAL）患儿血清成纤维细胞生长因子23（FGF23）和Klotho水平的变化，分析二者对疾病的诊断价值。方法 选取南京医科大学第一附属医院2018年1月至2020年3月收治的川崎病患儿110例，根据是否合并CAL分为川崎病合并CAL组（52例）和单纯川崎病组（58例），另选取南京医科大学第一附属医院同期体检健康儿童50名作为健康对照组。比较3组研究对象血清FGF23、Klotho、碱性磷酸酶（ALP）、缺血修饰白蛋白（IMA）、肌酸激酶同工酶（CK-MB）水平，分析川崎病患儿发生CAL的危险因素，川崎病合并CAL患儿血清FGF23水平与Klotho水平的相关性以及二者与血清ALP、IMA、CK-MB水平的相关性，评估血清FGF23和Klotho单独与联合检测对川崎病合并CAL的诊断价值。结果 川崎病合并CAL组血清FGF23、ALP、IMA、CK-MB水平均高于单纯川崎病组［(71±9)ng/L比（36±7）ng/L，(81±13)U/L比（61±9）U/L，(81±10)kU/L比（73±7）kU/L，(40±6)U/L比（35±6）U/L］和健康对照组，血清Klotho水平低于单纯川崎病组［(32±6)ng/L比（40±4）ng/L］和健康对照组（均P＜0.05）。川崎病合并CAL患儿血清FGF23水平与Klotho水平呈负相关（r=-0.814，P＜0.05），与ALP、IMA、CK-MB水平均呈正相关（r=0.761、0.787、0.769，均P＜0.001），血清Klotho水平与ALP、IMA、CK-MB水平均呈负相关（r=-0.722、-0.764、-0.670，均P＜0.001）。血清FGF23≥52.600 ng/L是川崎病患儿发生CAL的危险因素（比值比=5.098,95%置信区间：1.898~13.693，P=0.001），血清Klotho≥36.289 ng/L是川崎病患儿发生CAL的保护因素（比值比=0.897,95%置信区间：0.837~0.961，P=0.002）。血清FGF23和Klotho联合检测诊断川崎病合并CAL的曲线下面积均高于二者单独检测（0.863比0.782、0.744）。结论 川崎病合并CAL患儿血清FGF23水平升高、Klotho水平降低，二者联合检测有助于提高川崎病合并CAL的诊断价值。

• Objective To investigate the changes of serum fibroblast growth factor 23 (FGF23) and Klotho levels in pediatric patients with Kawasaki disease complicated with coronary artery lesion (CAL), and to analyze their diagnostic value. Methods Totally 110 pediatric patients with Kawasaki disease admitted to the First Affiliated Hospital with Nanjing Medical University from January 2018 to March 2020 were selected. They were divided into Kawasaki disease combined with CAL group (52 cases) and simple Kawasaki disease group (58 cases) according to the combination of CAL. Another 50 healthy children in the same period in the First Affiliated Hospital with Nanjing Medical University were selected as the healthy control group. The serum FGF23， Klotho, alkaline phosphatase (ALP), ischemia modified albumin (IMA) and creatine kinase isoenzyme (CK-MB) levels were compared among the three groups. The risk factors of CAL in pediatric patients with Kawasaki disease, the correlation between serum FGF23 level and Klotho level in Kawasaki disease patients combined with CAL, and the correlation of the two indexes and serum ALP, IMA, CK-MB levels were analyzed. The diagnostic values of serum FGF23 and Klotho alone and in combination on Kawasaki disease combined with CAL were evaluated. Results  The serum levels of FGF23, ALP, IMA, CK-MB of the Kawasaki disease combined with CAL group were higher than those of the simple Kawasaki disease group［(71±9)ng/L vs （36±7）ng/L，(81±13)U/L vs （61±9）U/L，(81±10)kU/L vs （73±7）kU/L，(40±6)U/L vs （35±6）U/L］ and the healthy control group; the serum Klotho level of the Kawasaki disease combined with CAL group was lower than that of the simple Kawasaki disease group［(32±6)ng/L vs （40±4）ng/L］ and the healthy control group (all P<0.05). In the Kawasaki disease combined with CAL group, serum FGF23 level was negatively correlated with Klotho level (r=-0.814, P<0.05), and positively correlated with ALP, IMA, CK-MB levels (r=0.761, 0.787, 0.769, all P<0.001). Serum Klotho level was negatively correlated with ALP, IMA, CK-MB levels (r=-0.722, -0.764, -0.670, all P<0.001). Serum FGF23≥52.600 ng/L was a risk factor for CAL in pediatric patients with Kawasaki disease ［odds ratio (OR) =5.098, 95% confidence interval (CI): 1.898-13.693,P=0.001］, and serum Klotho≥36.289 ng/L was a protective factor for CAL in pediatric patients with Kawasaki disease(OR=0.897, 95% CI: 0.837-0.961, P=0.002) . The area under the curve of combined detection of serum FGF23 and Klotho in the diagnosis of Kawasaki disease combined with CAL was higher than that of the two indexes alone (0.863 vs 0.782, 0.744). Conclusions The serum FGF23 level increases and Klotho level decreases in Kawasaki disease combined with CAL. The combined detection of the two indexes is helpful to improve the diagnostic value of Kawasaki disease combined with CAL.