静脉注射丙种球蛋白联合阿司匹林治疗川崎病疗效影响因素及预测模型构建

Factors affecting the efficacy of intravenous gammaglobulin combined with aspirin in the treatment of Kawasaki disease and the construction of a prediction model

目的探究影响静脉注射免疫球蛋白(IVIG)联合阿司匹林(ASP)治疗川崎病(KD)的疗效影响因素。方法回顾性分析2021年6月1日至2024年5月31日安徽医科大学附属安庆第一人民医院儿科就诊的KD患儿的临床资料,根据治疗效果分为有效组和无效组。采用单因素分析两组之间的差异临床特征。采用多因素Logistic回归分析KD患儿治疗无效的独立危险因素,并使用R软件构建列线图。采用受试者工作特征曲线(ROC)、校准曲线和决策曲线分析(DCA)分别评估列线图的区分能力、校准度和临床获益。结果研究共纳入80例KD患儿,有效组59例,无效组21例。单因素分析显示,两组发热时间、IVIG抵抗(IVIGR)、消化道出血、降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、白蛋白(ALB)和红细胞沉降率(ESR)差异有统计学意义(P<0.05);年龄、性别、体重指数、家庭平均月收入、早产儿、冠状动脉病变和呼吸道感染发生率差异无统计学意义(P>0.05)。多因素Logistic回归结果显示,IVIGR(是)、PCT(≥0.96 ng/mL)、CRP(≥41.98mg/L)、ALB(≤30.74g/L)和ESR(≥17.92 mm/h)是KD患儿治疗无效的独立危险因素。ROC分析显示,列线图预测KD患儿治疗无效的药时曲线下面积为0.989;校准曲线提示该列线图预测概率与实际概率大致吻合,DCA提示该列线图风险阈值为0.912时,使用该列线图临床净获益高于不使用该列线图模型临床净获益。结论IVIGR、PCT(≥0.96ng/mL)、CRP(≥41.98 mg/L)、ALB(≤30.74 g/L)和ESR(≥17.92 m/h)可用于KD患儿疗效不佳的预测。

Objective To explore the influencing factors of the therapeutic effect of intravenous immunoglobulin(IVIG)combined with aspirin(ASP)in the treatment of Kawasaki disease(KD).Methods The clinical data of children with KD who were treated in the Department of Pediatrics of Anqing First People's Hospital of Anhui Medical University from June lst,2021 to May 31,2024 were retrospectively analyzed.They were divided into the effective group and the ineffective group according to the therapeutic effect.Univariate analysis was used to explore the differences in clinical characteristics between the two groups.Multivariate Logistic regression analysis was used to explore the independent risk factors for ineffective treatment in children with KD,and the Nomogram was constructed using R software.Receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA)were used to evaluate the discriminatory ability,calibration degree,and clinical benefit of the Nomogram,respectively.Results A total of 80 children with KD were included in this study,with 59 cases in the effective group and 21 cases in the ineffective group.Univariate analysis showed that there were significant statistical differences in fever duration,IVIG resistance(IVIGR),gastrointestinal bleeding,procalcitonin(PCT),C-reaction protein(CRP),interleukin-6(IL-6),albumin(ALB)and erythrocyte sedimentation rate(ESR)between the two groups(P<0.05).In addition,there was no statistical significance in the comparisons of age,gender,body-mass index,average monthly family income,premature infants,coronary artery lesions and respiratory tract infection between the two groups(P>0.05).The results of multivariate Logistic regression showed that IVIGR(yes),PCT(≥0.96 ng/mL),CRP(≥41.98 mg/L),ALB(≤30.74 g/L)and ESR(≥17.92 mm/h)were independent risk factors for ineffective treatment in children with KD.ROC analysis showed that the area under the curve of the Nomogram for predicting ineffective treatment in children with KD was 0.989;the calibration curve suggested that the predicted probability of the Nomogram was approximately consistent with the actual probability,and the DCA suggested that when the risk threshold of the Nomogram was 0.912,the clinical net benefit of using the Nomogram was higher than that of not using the Nomogram model.Conclusion IVIGR(yes),PCT(≥0.96 ng/mL),CRP(≥41.98 mg/L),ALB(≤30.74 g/L),and ESR(≥17.92 mm/h)can be used to predict poor efficacy in children with KD.