系统免疫炎症指数在川崎病IVIG治疗抵抗患儿中的预测价值

The predictive value of systemic immune-inflammation index for intravenous immunoglobulin resistance in children with Kawasaki disease

目的评价系统免疫炎症指数(SII)对于川崎病(KD)患儿静脉注射免疫球蛋白(IVIG)治疗抵抗的预测价值。方法回顾性分析2018年1月—2022年3月在中国科学技术大学附属第一医院儿科诊断为KD并接受IVIG治疗的住院患儿445例,依据是否出现IVIG抵抗分为IVIG抵抗组(39例)和IVIG敏感组(406例);再依据血小板值进行分层分析。分别比较各组间炎症指标的差异;针对各差异指标,采用二元logistic回归分析研究其与KD患儿IVIG治疗抵抗的相关性;采用受试者工作特征(ROC)曲线评价各炎性指标预测KD患儿IVIG治疗抵抗的价值。结果整体KD患儿样本中,IVIG抵抗组较IVIG敏感组中性粒细胞(N)、中性粒细胞淋巴细胞比率(NLR)、血小板淋巴细胞比率(PLR)、SII、CRP水平高,淋巴细胞(L)较低,差异有统计学意义(均P<0.05);血小板减少KD患儿样本中,各炎症指标数值差异均无统计学意义;非血小板减少KD患儿样本中,IVIG抵抗组较IVIG敏感组N、NLR、SII水平高,差异有统计学意义(均P<0.05)。Logistic回归分析显示,整体样本和非血小板减少KD样本中,NLR与SII均为预测KD患儿IVIG治疗抵抗的因素;ROC曲线分析显示,NLR对于整体KD患儿IVIG抵抗预测敏感度为55%,特异度为67%;SII对于非血小板减少KD患儿IVIG抵抗预测敏感度为56%,特异度为64%。结论NLR对于整体KD患儿IVIG抵抗预测能力较强,SII对于非血小板减少KD患儿IVIG抵抗预测能力较强。

Objective To evaluate the predictive value of systemic immune-inflammation index(SII)for intravenous immunoglobulin(IVIG)resistance in children with Kawasaki disease(KD).Methods A total of 445 hospitalized children diagnosed with KD and treated with IVIG in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to March 2022 were retrospectively analyzed.According to the presence of IVIG resistance,they were divided into IVIG resistance group and IVIG sensitive group.Stratified analysis was performed according to platelet value.The differences of inflammatory indexes between each group were compared and binary logistic regression was used to analyze the correlation between each inflammatory index and IVIG-resistance in children with KD.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each inflammatory index for IVIG-resistance in children with KD.Results For all children with KD,inflammatory indexes including N,NLR,PLR,SII,and CRP of the IVIG-resistant group were higher than those of the IVIG-sensitive group(all P<0.05),and L was lower(P<0.05).For thrombocytopenia KD children,there was no statistical difference in the values of each inflammatory indexes.For non-thrombocytopenia KD children,the levels of N,NLR and SII of the IVIG-resistant group were higher than those of the IVIG-sensitive group(all P<0.05).Logistic regression analysis showed that both NLR and SII were independent risk factors for predicting IVIG resistance.ROC curve analysis showed that the sensitivity of NLR for predicting IVIG-resistance in allover the KD children was 55%,and the specificity was 67%.The sensitivity of SII for predicting IVIG-resistance in non-thrombocytopenic KD children was 56%,and the specificity was 64%.Conclusion NLR has a strong predictive ability for IVIG-resistance in allover children with KD,and SII has a strong predictive ability for IVIG-resistance in non-thrombocytopenic KD children.