系统免疫指数、中性粒细胞淋巴细胞比值对川崎病静脉注射免疫球蛋白敏感性的预测价值

Predictive values of systemic immune-inflammation index and neutrophil-to-lymphocyte ratio in sensitivity to intravenous immunoglobulin in Kawasaki disease

目的探讨系统性免疫指数(SII)、中性粒细胞淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)对川崎病(KD)患儿静脉注射免疫球蛋白(IVIg)敏感性的预测价值。方法回顾性分析2019年9月至2021年7月郑州大学第一附属医院收治的115例首诊KD患儿的完整临床资料,根据静脉注射免疫球蛋白敏感性分为IVIg敏感组和IVIg不敏感组,收集KD患儿静脉注射免疫球蛋白前发热天数、白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、血沉(ESR)、C-反应蛋白,并计算中性粒细胞计数×(血小板计数/淋巴细胞计数)(SII)、中性粒细胞淋巴细胞比值、血小板淋巴细胞比值。结果与IVIg敏感组相比,IVIg不敏感组NLR、C-反应蛋白水平较高,IVIg不敏感组PLT值、淋巴细胞计数、发热天数水平较低,差异均有统计学意义(P<0.05),IVIg不敏感组PLR、SII值较IVIg敏感组低,但差异无统计学意义(P>0.05)。NLR、C-反应蛋白、PLT最佳截留点分别为5.075、80.485 mg/L、347×10^(9)/L。经多因素logistic回归分析显示,NLR、CRP水平升高,PLT水平降低,分别为KD患儿静脉注射免疫球蛋白敏感性的独立危险因素。结论NLR对KD患儿静脉注射免疫球蛋白敏感性的预测性能更稳定,PLR、SII对KD患儿静脉注射免疫球蛋白敏感性的预测价值需要进一步探讨。

Objective To explore the predictive values of systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)in sensitivity to intravenous immunoglobulin in children with Kawasaki disease(KD).Methods The complete clinical data of 115 children with KD admitted to the First Affiliated Hospital of Zhengzhou University from September 2019 to July 2021 were retrospectively analyzed.According to the sensitivity to intravenous immunoglobulin,they were divided into the intravenous immunoglobulin sensitive group and the intravenous immunoglobulin non-sensitive group.The number of fever days,white blood cell count,neutrophil count,lymphocyte count,platelet count,erythrocyte sedimentation rate(ESR),and C-reactive protein values before intravenous immunoglobulin injection were collected in the intravenous immunoglobulin sensitive group.The SII(neutrophil count×platelet count/lymphocyte count),NLR,and PLR were calculated.Results Compared with the intravenous immunoglobulin sensitive group,the intravenous immunoglobulin insensitive group had higher levels of NLR and CRP.The PLT value,lymphocyte count,and number of fever days in the intravenous immunoglobulin insensitive group were lower than those in the intravenous immunoglobulin non-insensitive group,with statistically significant differences(P<0.05).The PLR and SII values in the intravenous immunoglobulin non-insensitive group were lower than those in the intravenous immunoglobulin sensitive group,without statistically significant differences(P>0.05).The best cut-off points for NLR,CRP,and PLT values were 5.075,80.485 mg/L,and 347×10^(9)/L,respectively.Multivariate logistic regression analysis indicated that increased level of NLR and CRP and decreased level of PLT were independent risk factors for the sensitivity to intravenous immunoglobulin in children with KD.Conclusion NLR has a more stable predictive performance in the sensitivity to intravenous immunoglobulin in children with KD.The predictive values of PLR and SII in the sensitivity to intravenous immunoglobulin in children with KD need to be further explored.