NLR与SII对川崎病患儿并发冠状动脉病变的诊断价值分析

The value of neutrophil lymphocyte ratio and systemic immune inflammatory index for diagnosis of coronary artery lesions in patients with Kawasaki disease

目的探讨中性粒细胞与淋巴细胞比值(NLR)、全身免疫炎症指数(SII)对川崎病急性期冠状动脉病变的诊断价值。方法该研究为横断面研究。纳入2018年1月至2021年12月临沂市中心医院收治的急性期川崎病患儿,根据是否并发冠状动脉病变分为川崎病并发冠状动脉病变组(KD-CAL组)和川崎病未并发冠状动脉病变组(KD-NCAL组)。收集患儿的人口学资料,静脉注射丙种球蛋白前的血常规和C反应蛋白(CRP)检测结果,并计算NLR和SII。采用多因素logistic回归模型分析川崎病患儿并发冠状动脉病变的关联因素。采用受试者工作特征(ROC)曲线分析NLR与SII对川崎病患儿并发冠状动脉病变的诊断价值。结果共入选患儿109例,年龄1个月~9岁,男童66例(60.6%),其中KD-CAL组17例、KD-NCAL组92例。两组患儿的年龄和性别构成差异均无统计学意义(均P>0.05)。与KD-NCAL组比较,KD-CAL组患儿的NLR、SII和CRP均较高(均P<0.05)。多因素logistic回归分析结果显示,NLR、SII是川崎病患儿并发冠状动脉病变的独立关联因素(NLR,OR=1.265,95%CI:1.066~1.502,P=0.007;SII,OR=1.001,95%CI:1.000~1.002,P=0.015)。ROC曲线结果显示,NLR对川崎病患儿并发冠状动脉病变诊断的最佳截断值为5.4,曲线下面积(AUC)为0.812(95%CI:0.703~0.921,P<0.05),敏感度为73.9%,特异度为76.5%;SII对川崎病患儿并发冠状动脉病变诊断的最佳截断值为1623,AUC为0.830(95%CI:0.741~0.919,P<0.05),敏感度为66.3%,特异度为88.2%;二者联合诊断川崎病患儿并发冠状动脉病变的AUC为0.875(95%CI:0.790~0.959,P<0.05),敏感度为85.9%,特异度为76.5%。结论NLR、SII及二者联合对急性期川崎病患儿并发冠状动脉病变具有较好的诊断价值,且二者联合的诊断价值优于单一指标。

Objective To investigate the value of neutrophil lymphocyte ratio(NLR)and systemic immune inflammatory index(SII)for the diagnosis of coronary artery lesions in patients with acute phase of Kawasaki disease(KD).Methods It was a cross-sectional study.Children with acute Kawasaki disease admitted to Linyi Central Hospital from January 2018 to December 2021 were enrolled and divided into the Kawasaki disease complicated with coronary artery disease group(KD-CAL group)and the Kawasaki disease without coronary artery disease group(KD-NCAL group).The demographic data,blood routine and C-reactive protein(CRP)test results before intravenous injection of γ globulin were collected,and NLR and SII were calculated.Multivariate logistic regression model was used to analyze the risk factors of coronary artery disease in children with Kawasaki disease.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of NLR and SII for coronary artery lesions in children with Kawasaki disease.Results A total of 109 children with acute phase of KD aged 1 month to 9 years were enrolled,including 66 boys(60.6%).There were no significant differences in age and gender composition between the KD-CAL group(n=17)and the KD-NCAL group(n=92)(all P>0.05).Compared with the KD-NCAL group,the NLR,SII and CRP levels in the KD-CAL group were higher(all P<0.05).Multivariate logistic regression analysis showed that NLR and SII were independent risk factors of coronary artery disease in children with Kawasaki disease(NLR,OR=1.265,95%CI:1.066-1.502,P=0.007;SII,OR=1.001,95%CI:1.000-1.002,P=0.015).ROC curve results showed that thearea under the curve(AUC)of NLR in diagnosis of coronary artery lesions was 0.812(95%CI:0.703-0.921,P<0.05),taking 5.4 as cutoff value,the sensitivity was 73.9%and specificity was 76.5%;the AUC of SII in diagnosis of coronary artery lesions was 0.830(95%CI:0.741-0.919,P<0.05),taking 1623 as the cut-off value,the sensitivity was 66.3%and specificity was 88.2%;the AUC of the combination of NLR and SII was 0.875(95%CI:0.790-0.959,P<0.05),the sensitivity and specificity were 85.9%and 76.5%,respectively.Conclusion NLR and SII have certain diagnostic value for coronary artery disease in children with acute Kawasaki disease,and the combination of NLR and SII has better value than single index.