临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (10): 765-.doi: 10.3969/j.issn.1000-3606.2018.10.010

• 综合报道 • 上一篇    下一篇

静脉注射丙种球蛋白无反应川崎病预测分析

肖蘭, 张静, 易伦羽, 邱玲, 杨莹, 叶晓春   

  1. 重庆医科大学附属儿童医院全科病房 儿童发育疾病研究教育部重点实验室 儿童发育重大疾病 国家国际科技合作基地 儿科学重庆市重点实验室(重庆 400014)
  • 收稿日期:2018-10-15 出版日期:2018-10-15 发布日期:2018-10-15
  • 通讯作者: 张静 E-mail:1720640149@qq.com

Predictive analysis of intravenous immunoglobulin unresponsive Kawasaki disease

 XIAO Lan, ZHANG Jing, YI Lunyu, QIU Ling, YANG Ying, YE Xiaochun   

  1. Department of General Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
  • Received:2018-10-15 Online:2018-10-15 Published:2018-10-15

摘要:  目的 评价不同评分系统对中国儿童静脉注射丙种球蛋白(IVIG)无反应川崎病的预测能效,探讨IVIG无反 应川崎病的危险因素,建立适用于中国儿童的IVIG无反应川崎病预测评分系统。方法 回顾分析1 655例中国川崎病儿 童临床资料,应用Kobayashi、Egami、Sano、付培培、Formosa及Tang评分预测其IVIG无反应,并评价其效能。应用单因素 分析、logistic 回归分析及受试者工作特征曲线(ROC)分析中国儿童初次IVIG无反应川崎病的独立危险因素,并尝试建 立新的预测评分系统。结果 血小板和血清钠越低,中性粒细胞百分比和总胆红素越高,IVIG无反应川崎病发生的风险 越高(P<0.05);上述4项危险因素用于建立新的预测评分系统,积分≥2分提示IVIG无反应川崎病。新的预测评分系统 的灵敏度为70.4%、特异度为72.7%,ROC曲线下面积为0.767。结论 血小板、中性粒细胞百分比、总胆红素和血清钠 与IVIG无反应川崎病相关。研究中建立的新的评分系统具有较高的灵敏度和特异度,但其在其他地区人群中的预测效能 有待进一步的证实。

Abstract:  Objective To evaluate the value of different scoring systems in the prediction of intravenous immunoglobulin (IVIG) unresponsive Kawasaki disease in Chinese children, and to explore the risk factors of IVIG unresponsive Kawasaki disease, so as to establish a predictive scoring system for IVIG unresponsive Kawasaki disease in Chinese children. Method The clinical data of 1 655 children with Kawasaki disease in China were analyzed retrospectively. The Kobayashi score, Egami score, Sano score, Fu score, Formosa score and Tang score were used to predict IVIG unresponsiveness of patients and their predictive capability were evaluated. Univariate analysis, logistic regression analysis and receiver operating characteristic curve (ROC) were used to analyze the independent risk factors of Kawasaki disease unresponsive to initial IVIG treatment in Chinese children, and a new predictive scoring system was attempted to establish. Results The incidence of IVIG unresponsive Kawasaki disease is higher in patients with lower platelets and serum sodium, higher percentage of neutrophils and total bilirubin (P<0.05). The above four risk factors were used to establish a new predictive scoring system, and the score ≥2 points suggested IVIG unresponsive Kawasaki disease. The new predictive scoring system have a sensitivity of 70.4%, a specificity of 72.7%, and an area under the ROC curve of 0.767. Conclusion Platelets, percentage of neutrophils, total bilirubin, and serum sodium were associated with IVIG unresponsive Kawasaki disease. The new scoring system established in this study has high sensitivity and specificity, but its predictive efficacy in other regions and populations needs further confirmation.