AST/ALT与川崎病患儿静脉注射丙种球蛋白无反应及冠状动脉损伤的相关性

The Correlation between AST/ALT and Unresponsiveness to Intravenous Immunoglobulin and Coronary Artery Lesion in Children with Kawasaki Disease

【目的】探讨天冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)与川崎病(KD)患儿静脉滴注丙种球蛋白(IVIG)无反应及冠状动脉损伤(CAL)的相关性。【方法】选取2018年6月至2021年5月咸阳彩虹医院收治的218例KD患儿,根据IVIG治疗情况将患儿分为敏感组(IVIG初治有效者)和无反应组(IVIG治疗无反应者),对比两组患儿AST、ALT及AST/ALT。根据KD患儿是否发生CAL将其分为发生组和未发生组,分析KD患儿发生CAL的影响因素,采用受试者工作特征(ROC)曲线评估AST/ALT预测KD患儿发生CAL的效能。【结果】无反应组患儿ALT水平高于敏感组,AST/ALT低于敏感组,差异有统计学意义(P<0.05)。治疗8周后,KD患儿CAL发生率为22.48%(49/218)。发生组IVIG治疗前发热持续时间,长于未发生组,IVIG无反应型比、PCT、ALT均高于未发生组(P<0.05),AST/ALT低于未发生组(P<0.05)。多因素Logistic分析结果显示,IVIG治疗无反应、ALT及AST/ALT均为KD患儿发生CAL的影响因素(P<0.05)。ROC曲线分析显示,AST/ALT评估KD患儿发生CAL的最佳截断点为0.63,灵敏度、特异度及AUC分别为83.67%、68.05%、0.803。【结论】IVIG无反应型KD患儿ALT较高,AST/ALT则较低,AST/ALT预测KD患儿发生CAL的临床价值较高。

【Objective】To investigate the relationship between Aspartate transaminase(AST)/alanine aminotransferase(ALT)and non response of intravenous immunoglobulin and coronary artery lesion(CAL)in children with Kawasaki disease(KD).【Methods】A total of 218 children with KD admitted to Xianyang Rainbow Hospital from June 2018 to May 2021 were selected.According to the treatment status of IVIG,the children were divided into a sensitive group(those who were initially effective in IVIG)and a non responsive group(those who were unresponsive to IVIG treatment).AST,ALT,and AST/ALT were compared between the two groups.KD patients were divided into occurrence and non occurrence groups based on whether they experienced CAL.The influencing factors for the occurrence of CAL in KD patients were analyzed,and the efficacy of AST/ALT in predicting the occurrence of CAL in KD patients was evaluated using the receiver operating characteristic(ROC)curve.【Results】The ALT level in the unresponsive group was higher than that in the sensitive group,while AST/ALT was lower than that in the sensitive group,with a statistically significant difference(P<0.05).After 8 weeks of treatment,the incidence of CAL in KD patients was 22.48%(49/218).The duration of fever before IVIG treatment,the ratio of IVIG unresponsive types,PCT,ALT in the occurrence group were higher than those in the non occurrence group(P<0.05),while AST/ALT was lower than those in the non occurrence group(P<0.05).The results of multivariate logistic analysis showed that IVIG treatment without response,ALT,and AST/ALT were all influencing factors for the occurrence of CAL in children with KD(P<0.05).The Receiver operating characteristic analysis showed that the best cut-off point for AST/ALT to assess the incidence of CAL in KD children was 0.63,and the sensitivity,specificity and AUC were 83.67%,68.05%and 0.803,respectively.【Conclusion】ALT is higher in IVIG unresponsive KD patients,while AST/ALT is lower.AST/ALT has a higher clinical value in predicting the occurrence of CAL in KD patients.