1~12月龄婴儿川崎病临床特点和免疫球蛋白不反应危险因素分析  

Clinical characteristics and risk factors of immunoglobulin nonresponse in 1-12 months infants with Kawasaki disease

作　　者：杜庆霞 周蔚然 董琳琳 王雪 张洪霞 李磊 DU Qing-Xia;ZHOU Wei-Ran;DONG Lin-Lin(Qilu Pediatric Hospital of Shandong University,Ji'nan Children,Hospital,Ji'nan,Shandong 250022,China)

机构地区：[1]山东大学齐鲁儿童医院济南市儿童医院,山东济南250022

出　　处：《中国妇幼保健》2021年第19期4476-4481,共6页Maternal and Child Health Care of China

基　　金：山东省重点研发项目(2017G00604)。

摘　　要：目的了解1~12月龄婴儿川崎病(KD)的临床特点和静脉注射免疫球蛋白(IVIG)不反应的危险因素。方法回顾性分析2017年1月-2019年12月在济南市儿童医院住院治疗KD患儿的临床特点,比较分析不完全川崎病(iKD)和完全性川崎病(cKD)的临床表现、冠状动脉损害(CAL)发生情况,通过单因素分析、多因素Logistic回归分析及ROC曲线对1~12月龄婴儿IVIG不反应的危险因素和预测因子进行分析。结果共144例1~12月龄KD婴儿纳入研究,平均年龄(6.48±3.20)个月,男女比例2.06∶1,CAL发生率为23.61%。发病具有季节性,5、6及7月份发病例数最多,占38.9%。144例患儿中,cKD 99例,iKD 45例,iKD组患儿出现KD典型的临床症状,如结膜充血、多形性红斑、淋巴结肿大、口唇及手足改变的概率低于cKD组。iKD组患儿HGB水平[(97.63±16.40)g/L]低于cKD组[(101.06±11.05)g/L],PLT[(554.67±218.75)×109/L]和ESR水平[(66.64±34.75)mm/h]高于cKD组[(431.47±157.90)×109/L、(54.24±26.33)mm/h],差异均有统计学意义(t=1.764、13.446及4.999,均P<0.05)。iKD组发生CAL的比例(48.84%)明显高于cKD组(13.13%),差异有统计学意义(χ^(2)=20.988,P<0.05);但两组间IVIG不反应比例(18.60%、24.24%)比较,差异无统计学意义(χ^(2)=0.546,P>0.05)。IVIG反应组与不反应组之间的单变量分析结果显示,NLR>2.848 6,PLR>148.863 6,应用丙种球蛋白时发热不足4.5 d与免疫球蛋白不反应有关,Logistic回归分析发现应用免疫球蛋白时发热不足4.5 d为免疫球蛋白不反应的独立危险因素,以此作为预测指标,ROC曲线下面积为0.691,灵敏度为0.690,特异度为0.915。结论 1~12月龄婴儿KD临床表现多不典型,iKD发生率高,iKD患儿较cKD患儿CAL发生率更高,但两组IVIG不反应比例无明显差异。应用丙种球蛋白时发热不足4.5 d对IVIG不反应具有一定的预测作用。Objective To analyze the clinical manifestations of Kawasaki disease(KD) and the possible risk factors of IVIG nonresponse in infants aged 1-12 months.Methods KD patients who were first diagnosed and treated in Ji’nan Children’s Hospital, from January 2017 to December 2019,were retrospectively collected.Compared and analyzed the clinical manifestations and CAL occurrence between incomplete Kawasaki disease(iKD) and complete Kawasaki disease(cKD).Univariate analysis, multivariate Logistic regression analysis and ROC curve were used to analyze the risk factors and predictors of IVIG nonresponse in infants aged 1-12 months.Results A total of 144 KD infants aged 1-12 months were included in the study.The mean age was(6.48±3.20) months the male to female ratio was 2.06∶1,and the incidence of CAL was 23.61%.The incidence is seasonal, with the most cases in May, June and July, accounting for 38.9%.There were 99 cases of cKD and 45 cases of iKD.iKD presented less incidences of superior conjunctival congestion, erythma pleomorphism, lymphadenopathy enlargement, and changes in lips and hands and feet than cKD.iKD children had lower hemoglobin level [(97.63±16.40)g/L] and higher platelet [(554.67±218.75) ×109/L],ESR levels [(66.64±34.75)mm/h]than cKD [(101.06±11.05)g/L,(431.47±157.90)×109/L,(54.24±26.33)mm/h],and the differences were statistically significant(t=1.764,13.446,4.999,P<0.05).The proportion of CAL in iKD group(48.84%) was significantly higher than that in cKD group(13.13%),and the difference was statistically significant.But there was no statistically significant difference in the proportion of IVIG non-response(iKD 18.60%,cKD 24.24%) between the two groups(χ^(2)=0.546,P>0.05).Univariate analysis between the IVIG response group and the non-response group showed that NLR > 2.8486,PLR > 148.863 6,and fever days before initial IVIG<4.50 days were corelated with IVIG nonresponse.Logistic regression analysis showed that less than 4.5 days of fever during the application of IVIG was an independent risk

关 键 词：川崎病 婴儿 免疫球蛋白不反应 冠脉损害 

分 类 号：R725[医药卫生—儿科]