川南地区静注人免疫球蛋白无反应型川崎病风险评分体系构建

Construction of Risk Scoring System for Intravenous Immunoglobulin Unresponsive Kawasaki Disease in Southern Sichuan

目的评价中国四种评分体系对川南地区静注人免疫球蛋白(IVIG)无反应型川崎病(KD)的预测能效,分析川南地区IVIG无反应型KD的危险因素,并建立风险评分体系。方法回顾性分析川南地区符合KD诊断标准的987例患儿临床资料,其中IVIG敏感组877例,IVIG无反应组110例,应用北京、上海、苏州、重庆四个地区评分体系对两组进行评分,进行单因素分析及多因素Logistic回归分析,得出川南地区IVIG无反应型KD的危险因素,再对各个危险因素进行赋值,得到川南地区的评分体系。结果 (1)上海、北京、苏州、重庆地区的评分体系敏感度分别为75. 5%、40%、23. 6%、44. 5%,特异度分别为40. 5%、90. 7%、88. 1%、64. 5%,(2)单因素分析提示皮疹、四肢改变、中性粒细胞比例(N-R)、淋巴细胞比例(N-R)、血红蛋白(HGB)、C反应蛋白(CRP)、总胆红素(TB)、红细胞压积(HCT)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)与IVIG无反应型KD相关,多因素logistic回归分析提示皮疹、TB、HGB、NLR为IVIG无反应型KD的危险因素,(3)新的评分体系:HGB≤108g/L(2. 5分); NLR> 3. 98(2. 5分); TB> 9. 6μmol/L(1. 5分);皮疹(1. 5分),当总分≥5时敏感度为57. 3%,特异度为75. 3%。结论中国的四种评分体系对于评价川南地区IVIG无反应型KD预测效能不高,可能并不适用于中国各个地区,新的评分体系敏感度偏低,特异度较高,但预测效能仍不理想。

Objective To evaluate the predictive efficiency of four scoring systems in China for the non-reactive Kawasaki disease(KD)of intravenous immunoglobulin(IVIG)in southern Sichuan,analyze the risk factors of IVIG non-reactive KD in South Sichuan,and establish a risk scoring system.Methods 987cases clinical data of children in South Sichuan,met KD diagnostic criteria,were retrospectively analyzed,including 877 cases in IVIG sensitive group and 110 cases in IVIG unresponsive group.Four regional scoring systems in Beijing,Shanghai,Suzhou and Chongqing were used to rate the two groups,and single factor analysis and multi-factor Logistic regression analysis were carried out,to get the risk factors of IVIG-reactive KD in South Sichuan,assign the risk factors,and establish the scoring system in South Sichuan.Results The sensitivity of scoring system in Shanghai,Beijing,Suzhou and Chongqing was 75.5%,40%,23.6% and 44.5% respectively,and the specificity was 40.5%,90.7%,88.1%,64.5.Single factor analysis suggested that the rash,limb change,neutrophils ratio(N-R),lymphocyte ratio(L-R),hemoglobin(HGB),C-reactive protein(CRP),total bilirubin(TB),erythrocyte effusion(HCT),neutrophils to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)were associated with IVIG reactive KD.Multi-Factor Logistic regression analysis suggested that the rash,TB,HGB and NLR were the risk factors for IVIG unresponsive KD.In the new scoring system,HGB≤108g/L counts 2.5 points;NLR>3.98 counts 2.5 points;TB>9.6μmol/L counts 1.5 points;and the rash counts 1.5 points,and when the total score isgreater than or equal to 5,the sensitivity is 57.3%and the specificity is 75.3%.Conclusion The four scoring systems in China are not effective in evaluating the predictive efficacy of IVIG non-reactive KD in South Sichuan,and they may not be suitable for all regions of China.The new scoring system is less sensitive and the specificity is high,but the predictive efficiency is still not ideal.