西安地区儿童免疫球蛋白无反应型川崎病危险因素分析及预测评分体系的建立

Analysis of Risk Factors of Intravenous Immunoglobulin in Children with Non-Responsive Kawasaki Disease in Xi'an Area and Establishment of Its Predictive Scoring System

目的分析西安地区儿童静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG)无反应型川崎病(kawasakidisease,KD)的危险因素,建立预测评分体系,为提高临床早期预测能力提供依据。方法回顾性分析2017年西安市儿童医院KD患儿临床资料,纳入符合KD诊断标准患儿共387例,其中IVIG敏感组336例,IVIG无反应组51例;采用单因素分析和多因素Logistic回归分析寻找西安地区KD儿童发生IVIG治疗无反应的独立危险因素,针对危险因素的临界值进行赋值,建立新的简单评分体系,并评价其有效性。结果单因素分析结果显示冠状动脉瘤、中性粒细胞百分比(N%)、总胆红素(TBIL)、间接胆红素(IBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和脑利钠肽前体(NT-proBNP)与IVIG无反应型KD相关(t或χ2=-2.47～8.78,均P<0.05);多因素Logistic回归分析结果显示冠状动脉瘤、N%,HCT,TBIL和AST是IVIG无反应型KD的独立危险因素(均P<0.05);建立新的简单评分体系,共纳入冠状动脉瘤、N%,HCT,TBIL,ALT,AST和BNP等7项指标(均P<0.05),当N%≥63%时赋值2分,其余6个量均赋值1分,总计8分,临界值为3分。ROC曲线下面积(AUC)为0.81(95%CI:0.74～0.89),灵敏度75%,特异度75%,约登指数为0.45。结论西安地区IVIG无反应型KD的预测评体系简单可行,可提高对该地区IVIG无反应型KD患儿的临床预测能力。

Objective To investigate the risk factors of intravenous immunoglobulin(IVIG)in children with non-responsive Kawasaki disease(KD)in Xi’an,and to establish a predictive scoring system to improve clinical prediction ability.Methods A retrospective analysis for the data of children with KD in Xi’an Children’s Hospital in 2017.387 children with KD met the criteria,includingn 336 IVIG sensitive patients and 51 IVIG non-responsive patients respectively.Combining the univariate analysis and multivariate logistic regression,the independent risk factors of IVIG for KD children in Xi’an were analyzed,and the odds ratio of risk factors was analyzed as well.A new simple scoring system was established with its effectiveness evaluated.Results Univariate analysis showed coronary aneurysm,neutrophil percentage(N%),total bilirubin(TBIL),indirect bilirubin(IBIL),alanine transferase(ALT),aspartate transferase(AST)and brain natriuretic peptide(NT-proBNP)were closely associated with IVIG-unresponsive KD(t/χ^2=-2.47~8.78,all P<0.05).Multivariate logistic regression analysis showed that coronary aneurysm,N%,HCT,TBIL and AST were independent risk factors for IVIGunresponsive KD(all P<0.05).The new simple score consisted seven indicators with a total of 8 points,including coronary aneurysm,N%,HCT,TBIL,ALT,AST and BNP(all P<0.05).In the system,N%≥63%were scored 2 points,and others were assigned 1 point and the positive result should be over 3 points.The area under the ROC curve(AUC)was 0.81(95%CI:0.74~0.89),the sensitivity was 75%,the specificity was 75%and the Youden’s index was 0.45.Conclusion A simple and effective new scoring system for IVIG non-responsive KD in Xi’an area was established,improving the clinical predictive ability of IVIG non-response in children with KD in this area.