血清TN-C、LRG1、sLR11对川崎病患儿静脉注射免疫球蛋白治疗无反应的预测价值

Predictive value of serum TN-C,LRG1 and sLR11 for non-response to intravenous immunoglobulin therapy in children with Kawasaki disease

目的探讨血清腱糖蛋白C(TN-C)、富含亮氨酸的α-2糖蛋白1(LRG1)、可溶性低密度脂蛋白受体11(sLR11)对川崎病患儿静脉注射免疫球蛋白(IVIG)治疗无反应的预测价值。方法回顾性选取2020年3月至2023年2月在石家庄市人民医院就诊的286例川崎病患儿为研究对象,均予以IVIG治疗,根据患儿对治疗的反应分为敏感组和无反应组。比较两组患儿临床资料,采用多因素logistic回归分析川崎病患儿IVIG治疗无反应的影响因素。采用ROC曲线评估血清TN-C、LRG1、sLR11单独和联合检测预测川崎病患儿IVIG治疗无反应的效能。结果286例患儿经IVIG治疗后,37例患儿对IVIG治疗无反应,发生率为12.94%。无反应组患儿WBC、中性粒细胞百分比、CRP、降钙素原、AST、ALT、血肌酐及血清TN-C、LRG1、sLR11水平均高于敏感组,血清钠水平则低于敏感组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,血清CRP、TN-C、LRG1及sLR11水平升高是川崎病患儿IVIG治疗无反应的独立危险因素(均P<0.05),而血清钠升高则是其保护因素(P<0.05)。ROC曲线分析结果显示,血清TN-C、LRG1、sLR11单独及联合检测预测川崎病患儿IVIG治疗无反应的AUC分别为0.755、0.658、0.789、0.898,三者联合检测的预测效能高于单独检测。结论血清TN-C、LRG1、sLR11水平升高均是影响川崎病患儿IVIG治疗无反应的危险因素,三者联合检测对预测患儿IVIG治疗无反应具有较高的临床价值。

Objective To investigate the predictive value of serum tenascin-C(TN-C),leucine-richα-2 glycoprotein 1(LRG1)and soluble low-density lipoprotein receptor relative with 11 ligand-binding repeats(sLR11)in non-response of children with Kawasaki disease to intravenous immunoglobulin(IVIG).Methods A total of 286 children with Kawasaki disease treated in Shijiazhuang People's Hospital from March 2020 to February 2023 were retrospectively selected as the study objects,all of whom were treated with IVIG.According to the response of patients to IVIG treatment,they were divided into sensitive group and non-response group.The clinical data in two groups were compared,and the influencing factors for their non-response to IVIG treatment were analyzed by multivariate logistic regression.ROC curve was used to evaluate the efficacy of serum TN-C,LRG1,and sLR11 alone and in combination on predicting non-response of patients to IVIG therapy.Results Among the 286 children treated with IVIG,37 did not respond to IVIG treatment,with an incidence of 12.94%.The levels of WBC,neutrophil percentage,CRP,procalcitonin,AST,ALT,serum creatinine,and serum TN-C,LRG1 and sLR11 in the no-response group were higher than those of the sensitive group,while the serum sodium level was lower,the differences of which were all statistically significant(all P<0.05).Multivariate logistic regression analysis showed that increased serum CRP,TN-C,LRG1 and sLR11 levels were independent risk factors for IVIG non response in children with Kawasaki disease(all P<0.05),while the increase of serum sodium was a protective factor(P<0.05).ROC curve analysis showed that the AUCs of serum TNC,LRG1 and sLR11 alone and combined detection in predicting non-response of patients to IVIG treatment were 0.755,0.658,0.789 and 0.898,respectively,and the combined detection of the three factors showed superior predictive performance to the single detection.Conclusion The elevated levels of serum TN-C,LRG1 and sLR11 are all risk factors for non-response to IVIG treatment in children with Kawasaki disease.The combined detection of these three factors has high clinical value for predicting their IVIG treatment non response.