实验室常见指标对川崎病早期诊断的价值  

Values of routine laboratory parameters in the early diagnosis of Kawasaki disease

作　　者：彭宇[1] 段炤[1] 王智[1] 康辉[1] 蒋曼[1] 李琳[1] 邹峥[1] 刘小惠[1] PENG Yu;DUAN Zhao;WANG Zhi;KANG Hui;JIANG Man;LI Lin;ZOU Zheng;LIU Xiaohui(Department of Rheumatology,Jiangxi Children′s Hospital,Nanchang,Jiangxi 330006,China)

机构地区：[1]江西省儿童医院风湿免疫科

出　　处：《重庆医学》2020年第1期43-48,共6页Chongqing medicine

基　　金：江西省卫生和计划生育委员会科技计划项目(20185445)

摘　　要：目的分析比较川崎病(KD)急性期和感染性发热患儿的实验室指标,探讨实验室常见指标对KD早期诊断的应用价值。方法对2016年1月至2017年12月在该院诊治的150例KD患儿(KD组)及60例感染性发热患儿(对照组)的血常规、生化等常见临床检测指标进行回顾性分析,采用多因素Logistic回归分析影响KD发生的危险因素,根据OR值对独立危险因素赋值建立评分模型,对预测结果及评分模型应用受试者工作特征(ROC)曲线分析各指标对KD的诊断价值。结果KD组白细胞、中性粒细胞、血小板(PLT)、C反应蛋白、红细胞沉降率(ESR)、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、乳酸脱氢酶、中性粒细胞与淋巴细胞比值(NLR)、PLT与淋巴细胞比值(PLR)明显高于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,PLT≥312×10^9/L、ESR≥30.2 mm/h、NLR≥3.22和PLR≥82.00是KD发生的独立危险因素。NLR和PLR诊断KD的曲线下面积(AUC)分别为0.901和0.912,高于PLT和ESR的0.672和0.686。通过对PLT≥312×10^9/L和ESR≥30.2 mm/h赋值1分,NLR≥3.22和PLR≥82.00赋值2分,建立评分模型,以总分4分为截断值,其鉴别KD和感染性发热疾病的灵敏度和特异度分别为83.7%和81.3%。结论新评分模型对于鉴别诊断KD和感染性发热具有良好的效果。Objective To explore the values of routinely used laboratory parameters in the early diagnosis of Kawasaki disease(KD)through analyzing the difference of these laboratory parameters between KD and infectious febrile disease.Methods The laboratory parameter of 150 patients with KD(the KD group)and 60 children with infectious fever(the control group)enrolled from January 2016 to December 2017 in hospital were analyzed retrospectively.The risk factors of KD were analyzed by Logistic multivariable regression,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic values of these indexes in KD.Results The levels of leucocyte,neutrophil,platelet(PLT),C-reactive protein,erythrocyte sedimentation rate(ESR),alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,neutrophil to lymphocyte ratio(NLR),PLT to lymphocyte ratio(PLR)in the KD group were significantly higher than those in the control group.Logistic multivariable regression analysis showed that PLT≥312×10^9/L,ESR≥30.2 mm/h,NLR≥3.22 and PLR≥82.00 were the independent risk factors of KD.The area under ROC curve(AUC)in PLT,ESR,NLR and PLR diagnosis of KD was 0.672,0.686,0.901,0.912,respectively.Generated a scoring system assigning 1 point for PLT≥312×10^9/L and ESR≥30.2 mm/h,as well as 2 points for NLR≥3.22 and PLR≥82.00,taking 4 point as the cut-off value,the sensitivity and specificity were 83.7%and 81.3%.Conclusion The new scoring system had a good effect in identify of KD and infection fever.

关 键 词：黏膜皮肤淋巴结综合征 感染 发热 健康状况指标 诊断 

分 类 号：R725[医药卫生—儿科]