川崎病患儿首次静脉注射免疫球蛋白耐药的预测因素  

The predictors of intravenous immunoglobulin resistance in patients with Kawasaki disease

作　　者：何永 康迁[1] 郑小艳[1] 皮光环 邓斌[1] 张家燕[1] HE Yong;KANG Qian;ZHENG Xiaoyan;PI Guanghuan;DENG Bin;ZHANG Jiayan(The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China;Sichuan Provincal Maternity and Child Health Care Hospital, Chengdu 610000, China)

机构地区：[1]川北医学院附属医院,四川南充637000 [2]四川省妇幼保健院,四川成都610000

出　　处：《西部医学》2021年第12期1831-1835,共5页Medical Journal of West China

摘　　要：目的探讨川崎病(KD)患儿首次静脉注射免疫球蛋白(IVIG)耐药的预测因素。方法回顾分析2015年1月~2018年12月川北医学院附属医院儿科诊断明确的279例川崎病患儿临床资料,根据首次使用IVIG后的效果将患儿分为IVIG耐药组和IVIG敏感组。对比两组患儿的一般资料、实验室检查指标、起病至首次输注IVIG的时间等。采用多因素Logistic回归分析IVIG耐药的独立危险因素,构建ROC曲线以确定危险因素的最佳预测界值及灵敏度、特异度。结果两组起病至首次输注IVIG的时间、中性粒细胞比例、低密度脂蛋白胆固醇(LDL-C)浓度、白蛋白(ALB)水平及心包积液发生率比较差异均有统计学意义(均P<0.05)。多因素分析显示,起病至初次输注IVIG的时间、ALB浓度、中性粒细胞比例是川崎病患者初次使用IVIG后发生耐药的独立危险因素。ROC曲线分析显示中性粒细胞百分比≥77.4%预测KD患者IVIG耐药的灵敏度和特异度分别为72.7%、75.7%,白蛋白≤26.7 g/L预测KD患者IVIG耐药的灵敏度和特异度分别为36.4%、92.8%,发热后5.5 d内首次使用IVIG预测KD患者IVIG耐药的灵敏度和特异度分别为89.9%、40.9%。结论起病至首次输注IVIG的时间、ALB浓度、中性粒细胞比例对预测KD患儿初次使用IVIG后耐药具有一定价值。Objective To investigate the predictive factors of intravenous immunoglobulin(IVIG)resistance in patients with Kawasaki disease(KD).Methods The data of 279 children with Kawasaki disease diagnosed in the Affiliated Hospital of North Sichuan Medical College from January 2015 to December 2018 were analyzed retrospectively.The subjects were divided into IVIG-resistant group and IVIG-sensitive group.Clinical data of the two groups were compared.Multivariate logistic regression was used to analyze the independent risk factors of IVIG resistance.ROC curve was used to analyze the predictors of intravenous immunoglobulin resistance.Results Univariate analysis showed that the time from onset to the use of IVIG,neutrophils proportion,LDL-C concentration,ALB concentration,the incidence of pericardial effusion were significantly different between the two groups.Multivariate analysis showed that shorter duration from onset to IVIG,lower ALB concentration and higher neutrophils percentage were independent predictors of IVIG resistance in Kawasaki disease.ROC curve was used to analyze the predictors of intravenous immunoglobulin resistance.When neutrophil percentage≥77.4%,the sensitivity and specificity to predict IVIG resistance in KD patients were 72.7%,75.7%.When albumin≤26.7g/l,the sensitivity and specificity were 36.4%,92.8%.The sensitivity and specificity of IVIG treatment for the first time within 5.5d after fever to predict IVIG resistance in KD patients were 89.9%and 40.9%,respectively.Conclusion The time from onset to the first IVIG infusion,ALB and the proportion of neutrophils have a certain value in predicting the drug resistance of KD patients after the first use of IVIG.

关 键 词：川崎病 静脉注射免疫球蛋白 耐药 预测因素 

分 类 号：R725.4[医药卫生—儿科]