川崎病患儿血清五聚蛋白-3水平对静脉注射免疫球蛋白抵抗的影响和预测价值

doi:10.12372/jcp.2023.22e1119

摘要/Abstract

摘要：

目的探讨川崎病（KD）患儿血清五聚蛋白-3（PTX3）水平对静脉注射免疫球蛋白（IVIG）抵抗的影响和预测价值。方法选择2017年1月—2022年7月诊治的KD患儿为研究对象，根据IVIG治疗情况判断是否存在IVIG抵抗，应用非条件二分类logistic回归分析PTX3与IVIG抵抗的关系，应用受试者工作特征（ROC）曲线分析PTX3预测IVIG抵抗的效能。结果纳入292例KD患儿，男187例、女105例，中位年龄25.0（10.0~32.0）月，出现IVIG抵抗49例（16.8%）。非条件二分类logistic回归分析显示，皮疹、颈淋巴结肿大、白细胞计数及CRP升高、血清钠下降、ALT≥33.2 IU/L、肌酐≥42.5 μmol/L、血清铁蛋白≥180.3 μg/L、PTX3≥19.3 ng/mL为影响IVIG抵抗的危险因素（P<0.05）。ROC曲线显示，PTX3预测IVIG抵抗的曲线下面积（AUC）为0.77（95%CI：0.68~0.85，P<0.001），具有中等准确度。取截断值21.5 ng/mL时，预测IVIG抵抗的灵敏度为 0.71，特异度为0.69，约登指数为0.40。结论 PTX3是影响KD患儿IVIG抵抗的独立危险因素，在预测IVIG抵抗方面具有较好效能。

关键词: 川崎病, 五聚蛋白-3, 静脉注射免疫球蛋白抵抗

Abstract:

Objective To explore the effect and predictive value of serum pentraxin-3 (PTX3) level on intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD). Methods Children with KD diagnosed and treated from January 2017 to July 2022 were selected as the study objects. IVIG resistance was determined according to the IVIG treatment outcome. The relationship between PTX3 and IVIG resistance was analyzed by binary logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of PTX3 in predicting IVIG resistance. Results A total of 292 KD children (187 boys and 105 girls) with a median age of 25.0 (10.0-32.0) months were included, and 49 patients (16.8%) showed IVIG resistance. Binary logistic regression analysis showed that the independent risk factors of IVIG resistance were rash, cervical lymph node swelling, increased white blood cell count and CRP, decreased serum sodium, ALT≥33.2 IU/L, creatinine≥42.5 μmol/L, serum ferritin≥180.3 μg/L and PTX3≥19.3 ng/mL. The ROC curve showed that the area under the curve (AUC) of PTX3 for predicting IVIG resistance was 0.77 (95%CI: 0.68~0.85, P<0.001), with moderate accuracy. When the cut-off value was 21.5 ng/mL, the sensitivity, specificity, and Youden index for predicting IVIG resistance were 0.71, 0.69, and 0.40 respectively. Conclusions PTX3 is an independent risk factor for IVIG resistance in KD children, and has a good effect in predicting IVIG esistance.

Key words: Kawasaki disease, pentraxin-3, intravenous immunoglobulin resistance

徐丹, 潘冬宁, 李亚琴. 川崎病患儿血清五聚蛋白-3水平对静脉注射免疫球蛋白抵抗的影响和预测价值[J]. 临床儿科杂志, 2023, 41(7): 502-506.

XU Dan, PAN Dongning, LI Yaqin. Effect and predictive value of serum pentraxin-3 level on intravenous immunoglobulin resistance in children with Kawasaki disease[J]. Journal of Clinical Pediatrics, 2023, 41(7): 502-506.

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项目	IVIG敏感组(n=243)	IVIG抵抗组(n=49)	统计量	P
皮疹[n(%)]	144(59.3)	39(79.6)	χ²=5.94	0.015
颈淋巴结肿大[n(%)]	70(28.8)	22(44.9)	χ²=4.89	0.027
白细胞[M(P₂₅~P₇₅)]×10⁹·L^-1	14.2(12.5~17.3)	16.3(14.8~19.8)	Z=2.72	0.007
中性粒细胞[M(P₂₅~P₇₅)]/%	57.5(50.3~62.8)	63.6(57.7~71.4)	Z=2.56	0.011
血小板[M(P₂₅~P₇₅)]×10⁹·L^-1	372.6(341.7~447.5)	338.2(293.3~410.6)	Z=2.19	0.029
APTT[M(P₂₅~P₇₅)]/s	22.2(17.8~29.5)	30.4(25.3~37.8)	Z=2.06	0.040
ALT[M(P₂₅~P₇₅)]/IU·L^-1	29.7(18.2~54.4)	49.6(26.3~118.7)	Z=2.64	0.008
肌酐[M(P₂₅~P₇₅)]/μmol·L^-1	39.4(31.8~52.5)	48.1(39.5~66.8)	Z=2.00	0.046
血清钠(x±s)/mmol·L^-1	136.1±5.7	134.2±5.3	t=2.15	0.032
血清铁蛋白[M(P₂₅~P₇₅)]/μg·L^-1	152.7(90.3~240.6)	252.7(136.4~469.2)	Z=2.75	0.006
CRP[M(P₂₅~P₇₅)]/mg·L^-1	56.4(42.5~68.7)	66.6(52.3~81.5)	Z=2.91	0.004
ESR[M(P₂₅~P₇₅)]/mm·h^-1	58.2(53.5~70.6)	69.7(63.1~80.2)	Z=2.37	0.018
cTnI[M(P₂₅~P₇₅)]/μg·L^-1	0.56(0.50~0.64)	0.64(0.55~0.74)	Z=2.13	0.034
NT-proBNP[M(P₂₅~P₇₅)]/ng·L^-1	654.8(585.6~749.3)	716.5(614.4~862.9)	Z=2.21	0.027
PTX3[M(P₂₅~P₇₅)]/ng·mL^-1	17.2(8.4~24.1)	32.1(17.4~51.6)	Z=2.82	0.005

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
皮疹	1.18	0.80	2.12	0.046	3.24(1.46~10.28)
颈淋巴结肿大	0.81	0.40	2.82	0.040	2.24(1.11~7.93)
白细胞	0.07	0.04	3.37	0.035	1.08(1.01~3.76)
血清钠	0.21	0.07	5.18	0.016	0.81(0.42~0.92)
CRP	0.05	0.03	3.98	0.031	1.05(1.02~1.73)
ALT≥33.2 IU·L^-1	0.02	0.01	5.78	0.009	1.02(1.00~1.09)
肌酐≥42.5 μmol·L^-1	0.04	0.02	4.83	0.021	1.04(1.01~1.22)
血清铁蛋白≥180.3 μg·L^-1	0.02	0.01	6.16	0.005	1.01(1.00~1.06)
PTX3≥19.3 ng·mL^-1	0.15	0.07	4.21	0.029	1.16(1.08~1.32)
常量	0.25	0.16	2.44	0.118	-