儿童川崎病发生冠状动脉损伤的危险因素分析及预测指标评价

Analysis of risk factors of coronary artery injury in children with Kawasaki disease and evaluation of predictive indicators

目的探讨儿童川崎病(KD)发生冠状动脉损伤(CAL)的危险因素,评价不同指标对KD患儿发生CAL预测能力。方法回顾性分析2011年1月-2018年6月本院儿科收治的KD患儿234例的临床资料,并根据彩色多普勒超声检查结果分为CAL组32例和非CA组202例,采用二元Logistic回归分析确定KD患儿发生CAL的危险因素,并应用ROC曲线评价不同预测指标对KD患儿发生CAL的预测能力及最佳界值。结果234例KD患儿发生CAL 32例,发生率为13.7%;经二元Logistic回归分析显示,IVIG治疗延迟、IVIG抵抗、发热持续时间>10 d、高PLT、低ALB是KD患者发生CAL的独立危险因素(P<0.05),IVIG治疗延迟表现出更高的CAL发生风险(OR=5.496,P<0.05)。联合PLT计数和ALB两项指标诊断KD并发CAL的ROC曲线下面积(AUC)为0.845,灵敏度为0.843,特异度为0.784,优于单一指标。结论KD患者发生CAL危险因素较多,联合PLT计数和ALB回归模型能够提高对KD患儿发生CAL的预测能力。

Objective To investigate the risk factors of coronary artery injury(CAL)in children with Kawasaki disease(KD)and evaluate the predictive ability of different indexes for children with KD.Methods The clinical data of 234 patients with KD who were treated in pediatrics from January 2011 to June 2018 were retrospectively analyzed.According to the results of color Doppler ultrasonography,32 patients were classified into CAL group and 202 were non-CA group.The Logistic regression analysis was used to determine the risk factors of CAL in children with KD.The ROC curve was used to evaluate the predictive ability and the best cut-off value of different predictors for children with KD.Results There were 32 cases of CAL in 32 children with KD,and the incidence was 13.7%.The binary Logistic regression analysis showed that male,IVIG treatment delay,IVIG resistance,fever duration>10 days,high PLT,and low ALB were independent risk factors for CALs in KD patients(P<0.05);IVIG treatment delay showed a higher risk of CAL(P<0.05).The area under the ROC curve(AUC)of KD-associated PLT counts and ALB indexes was 0.845,the sensitivity was 0.843,and the specificity was 0.784,which was superior to a single index.Conclusion There are more risk factors for CAL in KD patients.Combined PLT count and ALB regression model can improve the prediction ability of CAL in children with KD.