[1]李俏,张李钰,赵传梅,等.西安地区儿童免疫球蛋白无反应型川崎病危险因素分析及预测评分体系的建立[J].现代检验医学杂志,2019,34(01):5-9.[doi:10.3969/j.issn.1671-7414.2019.01.002]
　LI Qiao,ZHANG Li-yu,ZHAO Chuan-mei,et al.Analysis of Risk Factors of Intravenous Immunoglobulin in Children with Non-Responsive Kawasaki Disease in Xi’an Area and Establishment of Its Predictive Scoring System[J].Journal of Modern Laboratory Medicine,2019,34(01):5-9.[doi:10.3969/j.issn.1671-7414.2019.01.002]
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西安地区儿童免疫球蛋白无反应型川崎病危险因素分析及预测评分体系的建立()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第34卷
期数:
2019年01期
页码:
5-9
栏目:
论著
出版日期:
2019-02-28

文章信息/Info

Title:
Analysis of Risk Factors of Intravenous Immunoglobulin in Children with Non-Responsive Kawasaki Disease in Xi’an Area and Establishment of Its Predictive Scoring System
文章编号:
1671-7414( 2019)01-005-05
作者:
李俏; 张李钰; 赵传梅; 吴爽; 曹三成
(西安市 儿童医院，西安710000)
Author(s):
LI Qiao; ZHANG Li-yu; ZHAO Chuan-mei; WU Shuang; CAO San-cheng
(Xi’an Children’s Hospital，Xi’an 710000，China)
关键词:
川崎病; 免疫球蛋白; 危险因素
分类号:
R543；R392.1
DOI:
10.3969/j.issn.1671-7414.2019.01.002
文献标志码:
A
摘要:
目的分析西安地区儿童静脉注射免疫球蛋白(intravenous immunoglobulin，IVIG)无反应型川崎病(kawasaki disease，KD)的危险因素，建立预测评 分体系，为提高临床早期预测能力提供依据。方法回顾性分析2017 年西安市儿童医院KD患儿临床资料，纳入符合KD诊断标准患儿共387例，其中IVIG敏感组336 例，IVIG无反应组51例；采用单因素分析和多因素Logistic回归分析寻找西安地区KD儿童发 生IVIG治疗无反应的独立危险因素，针对危险因素的临界值进行赋值，建立新的简单评分体 系，并评价其有效性。结果单因素分析结果显示冠状动脉瘤、中性 粒细胞百分比(N%)、总胆红素(TBIL)、间接胆红素(IBIL)、丙氨酸氨基转移酶(ALT)、天冬 氨酸氨基转移酶(AST)和脑利钠肽前体(NT-proBNP)与IVIG无反应型KD相关( t或χ 2=- 2.47~8.78，均 P ＜0.05)；多因素Logistic回归分析结果显示冠状动脉瘤、N%，HC T，TBIL和AST是IVIG无反应型KD的独立危险因素(均 P ＜0.05)；建立新的简单评分体系 ，共纳入冠状动脉瘤、N%，HCT，TBIL，ALT，AST和BNP等7项指标(均 P ＜0.05)，当N% ≥63%时赋值2分，其余6个量均赋值1分，总计8分，临界值为3分。ROC曲线下面积(AUC)为0 .81(95%CI：0.74~0.89)，灵敏度75%，特异度75%，约登指数为0.45。结论 西安地区IVIG无反应型KD的预测评体系简单可行，可提高对该地区IVIG无反应 型KD患儿的临床预测能力。
Abstract:
Objective To investigate the risk factors of intravenous immunoglobulin (IVIG) in children with non-resp onsive Kawasaki disease (KD) in Xi’an， and to establish a predictive scoring s ystem to improve clinical prediction ability．Methods A r etrospective analysis for the data of children with KD in Xi’an Children’s Hos pital in 2017．387 children with KD met the criteria，includingn 336 IVIG sensi tive patients and 51 IVIG non-responsive patients respectively．Combining the u nivariate analysis and multivariate logistic regression，the independent risk fa ctors of IVIG for KD children in Xi’an were analyzed，and the odds ratio of ris k factors was analyzed as well．A new simple scoring system was established with its effectiveness evaluated．Results Univariate analysis showed coronary aneurysm，neutrophil percentage (N%)，total bilirubin (TBIL)，i ndirect bilirubin (IBIL)，alanine transferase (ALT)，aspartate transferase (AST) and brain natriuretic peptide (NT-proBNP) were closely associated with IVIG-u nresponsive KD ( t/χ 2=-2.47~8.78，all P <0.05)．Multivariate logist ic regression analysis showed that coronary aneurysm，N%，HCT，TBIL and AST were independent risk factors for IVIG-unresponsive KD (all P <0.05)．The new s imple score consisted seven indicators with a total of 8 points，including coron ary aneurysm，N%，HCT，TBIL，ALT，AST and BNP (all P <0.05)．In the system， N%≥63% were scored 2 points，and others were assigned 1 point and the positive result should be over 3 points．The area under the ROC curve (AUC) was 0．81 (9 5% CI：0.74~0.89)，the sensitivity was 75%，the specificity was 75% and the Yo uden’s index was 0.45．Conclusion A simple and effectiv e new scoring system for IVIG non-responsive KD in Xi’an area was established ，improving the clinical predictive ability of IVIG non-response in children wi th KD in this area．

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备注/Memo

备注/Memo:
基金项目：陕西省社会发展科技攻关项目(2016SF-036)。
作者简介：李俏(1988-)，女，博士，主管技师，研究方向：临床 生物化学与分子生物学，E-mail：liqiaoey@163.com。
通讯作者：曹三成，主任技师，西安市儿童医院检验科主任，E- mail：jianyan2080@163.com。
更新日期/Last Update: 2019-02-28