超声心动图联合实验室检查预测静脉注射丙种球蛋白无反应性川崎病的价值  

The value of echocardiography combined with laboratory examination in predicting intravenous immunoglobulin unresponsive Kawasaki disease

作　　者：文杨 刘健 姚海波 金梅 杨胜 马荣川 Wen Yang;Liu Jian;Yao Haibo;Jin Mei;Yang Sheng;Ma Rongchuan(Department of Ultrasound,Chengdu Women′s and Children′s Central Hospital(School of Medicine,University of Electronic Science and Technology of China),Chengdu 611731,China;Department of Ultrasound,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China;Department of Medical Records and Statistics,Chengdu Women′s and Children′s Central Hospital(School of Medicine,University of Electronic Science and Technology of China),Chengdu 611731,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院(成都市妇女儿童中心医院)超声影像科,成都611731 [2]成都医学院第一附属医院超声科,610500 [3]电子科技大学医学院附属妇女儿童医院(成都市妇女儿童中心医院)病案统计科,成都611731

出　　处：《中华诊断学电子杂志》2025年第1期51-58,共8页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：成都市卫健委科研项目(2021131)。

摘　　要：目的探讨超声心动图(UCG)联合实验室检查在预测静脉注射丙种球蛋白(IVIG)治疗无反应性川崎病(KD)中的应用价值。方法收集2019年9月至2023年9月成都市妇女儿童中心医院儿童心脏内科收治的164例KD患儿,依据对IVIG治疗的敏感情况,分为IVIG无反应组(n=82)和IVIG反应组(n=82)。比较两组治疗前UCG表现、实验室检查指标,并采用多因素Logistic回归预测发生IVIG无反应的高危因素,绘制受试者操作特征(ROC)曲线,评价预测效能。结果IVIG无反应组冠状动脉(CA)扩张比例比IVIG反应组更高[37.80%(31/82),20.73%(17/82)],差异有统计学意义(χ^(2)=5.773,P=0.016)。三尖瓣反流(TR)、丙氨酸氨基转氨酶(ALT)>40 U/L、白蛋白(ALB)<35 g/L、D-二聚体(D-Dimer)>0.5 mg/L、中性粒细胞与淋巴细胞计数比值(NLR)>1.29、血小板(PLT)>420×10^(9)/L、血小板与淋巴细胞计数比值(PLR)>126.8是发生IVIG无反应的独立危险因素[OR=19.136(95%CI:3.634~100.756),1.016(95%CI:1.007~1.025),0.912(95%CI:0.835~0.996),1.780(95%CI:1.091~2.904),0.812(95%CI:0.681~0.969),1.014(95%CI:1.007~1.022),1.022(95%CI:1.006~1.037);均P<0.05]。双联合中TR联合PLT的ROC曲线下面积为0.850,敏感度为63.41%,特异度为95.12%;三联合中TR联合ALT及PLT的ROC曲线下面积为0.903,敏感度为80.49%,特异度为86.59%;多联合中TR联合ALT、PLT、ALB、D-Dimer及PLR共6项指标的ROC曲线下面积为0.946,敏感度为86.59%,特异度为92.68%。结论KD患儿CA扩张、TR、ALT水平升高、ALB降低、D-Dimer升高、NLR升高、PLT升高、PLR升高、血沉升高等是发生IVIG无反应的高危因素。UCG联合实验室检查可为预测IVIG无反应发生提供更准确的价值。Objective To investigate the application value of echocardiography(UCG)combined with laboratory examination in predicting unresponsive Kawasaki disease(KD)intravenous immunoglobulin(IVIG)treatment.Methods The data of total of 164 children with KD admitted to the Children′s Cardiography Department of Chengdu Women and Children′s Central Hospital from September 2019 to September 2023 were collected.According to the sensitivity to IVIG treatment,the children were divided into the IVIG nonresponse group(n=82)and the IVIG response group(n=82).The UCG performance and laboratory examination indexes before treatment were compared between the two groups.Multivariate Logistic regression was used to predict the risk factors for IVIG non-response,and receiver operating characteristic(ROC)curve was drawn to evaluate the prediction efficacy.Results The proportion of coronary artery(CA)dilation in the IVIG non-response group was higher than that in the IVIG response group[37.80%(31/82),20.73%(17/82)],and the difference was statistically significant(χ^(2)=5.773,P=0.016).Tricuspid regurgitation(TR),alanine aminotransferase(ALT)>40 U/L,albumin(ALB)<35 g/L,D-Dimer>0.5 mg/L,neutrophil to lymphocyte ratio(NLR)>1.29,platelet(PLT)>420×10^(9)/L,platelet and lymphocyte ratio(PLR)>126.8 were independent risks factors for IVIG non-response[OR=19.136(95%CI:3.634-100.756),1.016(95%CI:1.007-1.025),0.912(95%CI:0.835-0.996),1.780(95%CI:1.091-2.904),0.812(95%CI:0.681-0.969),1.014(95%CI:1.007-1.022),1.022(95%CI:1.006-1.037),all P<0.05].The area under the ROC curve of TR combined with PLT was 0.850,the sensitivity was 63.41%,and the specificity was 95.12%.The area under the ROC curve of TR combined with ALT and PLT was 0.903,the sensitivity was 80.49%,and the specificity was 86.59%.The area under the ROC curve of TR combined with ALT,PLT,ALB,D-Dimer and PLR was 0.946,the sensitivity was 86.59%,and the specificity was 92.68%.Conclusions CA dilation,TR,ALT elevation,ALB reduction,D-Dimer elevation,NLR elevation,PLT elevation,PLR elevation,eryt

关 键 词：川崎病 丙种球蛋白 无反应 超声心动图 危险因素 

分 类 号：R72[医药卫生—儿科]