心率变异性指标联合血清SF、PTX3对川崎病患儿静脉注射免疫球蛋白治疗敏感性的预测价值

Predictive Value of Heart Rate Variability Indexes Combined with Serum SFand PTX3 on the Sensitivity of Intravenous Immunoglobulinin Children with Kawasaki Disease

目的:探讨心率变异性(HRV)指标联合血清铁蛋白(SF)、正五聚蛋白-3(PTX3)对川崎病(KD)患儿静脉注射免疫球蛋白(IVIG)治疗敏感性的预测价值。方法:251例急性期KD患儿均接受IVIG联合阿司匹林治疗,治疗前检测患儿HRV指标和血清SF、PTX3水平,根据IVIG治疗反应将患儿分为IVIG无反应组(33例)和IVIG敏感组(218例)。多因素Logistic回归分析影响KD患儿IVIG治疗敏感性的相关因素以及使用受试者工作特征(ROC)曲线分析HRV指标联合SF、PTX3预测KD患儿IVIG治疗敏感性的价值。结果:IVIG敏感组正常窦性NN间期标准差(SDNN)、低频功率(LF),高频功率(HF)、低频功率/高频功率(LF/HF)高于IVIG无反应组(P<0.05),血清SF、PTX3水平低于IVIG无反应组(P<0.05)。多因素Logistic回归分析显示高SF、高PTX3是KD患儿IVIG治疗敏感性的危险因素(P<0.05),高LF/HF是KD患儿IVIG治疗敏感性的保护因素(P<0.05)。ROC曲线分析显示LF/HF、SF、PTX3预测KD患儿IVIG敏感性的曲线下面积分别为0.844、0.792、0.785,三者联合预测曲线下面积为0.933,高于单独预测。结论:IVIG治疗敏感的KD患儿HRV指标LF/HF增高,血清SF、PTX3水平降低,HRV指标LF/HF联合SF、PTX3可有效预测KD患儿IVIG治疗敏感性。

Objective:To investigate the predictive value of heart rate variability(HRV)indexes combined with serum ferritin(SF)and pentraxin-3(PTX3)on the sensitivity of intravenous immunoglobulin(IVIG)in children with Kawasaki disease(KD).Methods:251 acute KD children were treated with IVIG combined with aspirin,HRV indexes and serum SF and PTX3 levels were detected before treatment,the children were divided into IVIG non-response group(33 cases)and IVIG sensitive group(218 cases)according to the re-sponse to IVIG treatment.The related factors affecting the sensitivity of IVIG treatment in KD children were analyzed by multivariate Logistic regression analysis and the value of HRV indexes combine with SF and PTX3 in predicting the sensitivity of IVIG treatment in KD children was analyzed by receiver operating characteristic(ROC)curve.Results:The standard deviation of normal sinus NN interval(SDNN),low frequency power(LF),high frequency power(HF),low frequency power/high frequency power(LF/HF)in IVIG sensitive group were higher than those in IVIG non-response group(P<0.05),and the serum SF and PTX3 levels were lower than those in IVIG non-response group(P<0.05).Multivariate Logistic regression analysis showed that high SF and high PTX3 were risk factors for IVIG treatment sensitivity in KD children(P<0.05),and high LF/HF was a protective factor for IVIG treatment sensitivity in KD children(P<0.05).ROC curve analysis showed that the area under the curve of LF/HF,SF and PTX3 in predicting IVIG sensitivity in KD children was 0.844,0.792 and 0.785 respectively,the area under the curve of the combine prediction of the three was 0.933,which was higher than that of the single prediction.Conclusion:The HRV indexes LF/HF increase and the serum SF and PTX3 levels decrease in KD children sensitive to IVIG treatment,the HRV indexes LF/HF combine with SF and PTX3 can effectively predict the sensitivity of IVIG treatment in KD children.