NLR联合MPVLR对川崎病并发冠状动脉损害的预测价值

The predictive value of NLR combined with MPVLR for coronary artery lesions in Kawasaki disease.

目的探讨中性粒细胞-淋巴细胞比值(NLR)联合平均血小板体积与淋巴细胞比值(MPVLR)对川崎病(KD)并发冠状动脉损害(CALs)的预测价值。方法选取2018年1月至2023年1月于安徽医科大学第一附属医院儿科住院治疗的264例KD患儿为研究对象,按照超声心动图结果分为冠状动脉损害组(CALs组,n=34)及非冠状动脉损害组(nCALs组,n=230),收集患儿的基本临床资料及外周血细胞参数,并计算NLR和MPVLR,比较两组之间各指标的差异,使用二元logistic回归分析KD并发CALs的独立危险因素。应用受试者工作特征(ROC)曲线分析NLR、MPVLR独立及两者联合预测KD并发CALs的效能。结果CALs组白细胞(WBC)、血小板(PLT)计数及NLR、MPVLR水平较nCALs组增高,差异具有统计学意义(P<0.05)。二元logistic回归分析显示,WBC(OR=1.236,95%CI:1.115~1.371,P<0.001)、PLT(OR=1.004,95%CI:1.001~1.007,P=0.008)、NLR(OR=1.091,95%CI:1.001~1.189,P=0.046)、MPVLR(OR=1.160,95%CI:1.008~1.336,P=0.038),为CALs的独立危险因素。NLR预测CALs的最佳截断值为3.93,灵敏度为76.43%,特异度为69.82%,AUC为0.762(95%CI:0.714~0.805,P<0.001);MPVLR预测CALs的最佳截断值为3.53,灵敏度为72.69%,特异度为62.83%,AUC为0.721(95%CI:0.671~0.767,P<0.001)。NLR联合MPVLR预测CALs的灵敏度为78.12%,特异度为68.68%,AUC为0.775(95%CI:0.728~0.817,P<0.001)。结论外周血细胞参数中NLR、MPVLR对预测KD并发CALs具有重要价值,NLR联合MPVLR预测KD并发CALs的效能更高。

Objective To investigate the predictive value of the neutrophil-to-lymphocyte ratio(NLR)combined with mean platelet volume-to-lymphocyte ratio(MPVLR)for coronary artery lesions(CALs)in Kawasaki disease(KD).Methods We selected 264 KD patients admitted to the Pediatric Department of the First Affiliated Hospital of Anhui Medical University from January 2018 to January 2023.Based on echocardiographic results,the patients were categorized into the CALs group(n=34)and the non-CALs group(nCALs,n=230).We collected the clinical data and peripheral blood cell parameters,calculated NLR and MPVLR,compared the differences in various indicators between the two groups,and used binary logistic regression analysis to identify independent risk factors for KD with CALs.We applied receiver operating characteristic(ROC)curve analysis to evaluate the efficacy of NLR,MPVLR,and their combination in predicting CALs in KD.Results White blood cell(WBC)and platelet(PLT)counts,as well as NLR and MPVLR levels in the CALs group were significantly higher than those in the nCALs group,with statistically significant differences(P<0.05).Binary logistic regression analysis revealed that WBC(OR=1.236,95%CI:1.115~1.371,P<0.001),PLT(OR=1.004,95%CI:1.001~1.007,P=0.008),NLR(OR=1.091,95%CI:1.001~1.189,P=0.046),and MPVLR(OR=1.160,95%CI:1.008~1.336,P=0.038)were independent risk factors for CALs.The optimal cutoff value for NLR in predicting CALs was 3.93,with a sensitivity of 76.43%,specificity of 69.82%,and AUC of 0.762(95%CI:0.714~0.805,P<0.001).For MPVLR,the optimal cutoff value was 3.53,with a sensitivity of 72.69%,specificity of 62.83%,and AUC of 0.721(95%CI:0.671~0.767,P<0.001).The sensitivity and specificity of NLR combined with MPVLR in predicting CALs was 78.12%and 68.68%,respectively,with an AUC of 0.775(95%CI:0.728~0.817,P<0.001).Conclusion Peripheral blood cell parameters,particularly NLR and MPVLR,hold significant value in predicting CALs in KD.The combined efficacy of NLR and MPVLR in predicting CALs is superior.