川崎病患儿红细胞分布宽度变化及意义

Changes and significance of red blood cell distribution width of Kawasaki disease in children

目的 探讨川崎病(KD)患儿红细胞分布宽度(RDW)的变化及临床意义.方法 选取2014年1月至2019年5月初诊的185例KD住院患儿,根据治疗前心脏超声检查结果分为合并冠脉损伤组(CAL组,24例)和未合并冠脉损伤组(nCAL组,161例),另选取同期健康儿童50例作为对照组.比较各组RDW以及白细胞计数(WBC)、血小板计数(PLT)、血沉(ESR)、C反应蛋白(CRP)、丙氨酸转氨酶(ALT)及白蛋白(ALB)水平的差异.经多元logistic回归分析筛查KD合并CAL的独立危险因素.应用受试者工作特征曲线(ROC)分析急性期RDW预测KD合并CAL的效能.结果 KD组患儿的RDW、WBC、PLT、ESR、CRP及ALT水平均高于对照组,ALB水平低于对照组,差异有统计学意义(P均<0.05).CAL组与nCAL组间RDW、WBC、CRP、ALB及热程的差异有统计学意义(P均<0.05).多元logistic回归分析表明,RDW、WBC、CRP、ALB及热程均为CAL发生的影响因素,且RDW与WBC、CRP水平呈正相关,与ALB水平呈负相关.RDW≥13.35%预测KD合并CAL的灵敏度为87.5%、特异度为68.3%,ROC曲线下面积(AUC)为0.827(95%CI:0.749~0.905,P<0.001).结论RDW水平变化可以作为早期预测KD患儿CAL的重要指标之一.

Objective To explore the change and clinical significance of red blood cell distribution width(RDW)in children with Kawasaki disease(KD).Methods A total of 185 hospitalized children newly diagnosed with KD from January 2014 to May 2019 were selected.According to the results of echocardiography before treatment,patients were divided into coronary artery lesion group(CAL group,24 cases)and non-coronary artery lesions group(nCAL group,161 cases).And another 50 healthy children in the same period were selected as the control group.The differences of RDW,white blood cell count(WBC),platelet count(PLT),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),alanine aminotransferase(ALT),and albumin(ALB)levels among groups were compared.The independent risk factors of KD combined with CAL were screened by multiple logistic regression analysis.The efficacy of RDW in predicting KD combined with CAL in acute phase was analyzed by receiver operating characteristic(ROC)curve.Results The levels of RDW,WBC,PLT,ESR,CRP,and ALT in KD group were higher than those in the control group,and the levels of ALB in KD group were lower than those in the control group(all P<0.05).The differences of RDW,WBC,CRP,ALB,and fever duration between CAL group and nCAL group were statistically significant(all P<0.05).Multiple logistic regression analysis showed that RDW,WBC,CRP,ALB,and fever duration were all influencing factors of CAL occurrence,and RDW was positively correlated with WBC and CRP levels and negatively correlated with ALB levels.The sensitivity and specificity of RDW≥13.35%were 87.5%and 68.3%in predicting KD with CAL respectively,and the area under the ROC curve(AUC)was 0.827(95%CI:0.749~0.905,P<0.001).Conclusions The changes of RDW level can be used as one of the important indexes for early prediction of CAL in KD children.