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系统免疫炎症指数在川崎病IVIG治疗抵抗患儿中的预测价值

储安贞 张兰

储安贞, 张兰. 系统免疫炎症指数在川崎病IVIG治疗抵抗患儿中的预测价值[J]. 中华全科医学, 2022, 20(11): 1884-1888. doi: 10.16766/j.cnki.issn.1674-4152.002727
引用本文: 储安贞, 张兰. 系统免疫炎症指数在川崎病IVIG治疗抵抗患儿中的预测价值[J]. 中华全科医学, 2022, 20(11): 1884-1888. doi: 10.16766/j.cnki.issn.1674-4152.002727
CHU An-zhen, ZHANG Lan. The predictive value of systemic immune-inflammation index for intravenous immunoglobulin resistance in children with Kawasaki disease[J]. Chinese Journal of General Practice, 2022, 20(11): 1884-1888. doi: 10.16766/j.cnki.issn.1674-4152.002727
Citation: CHU An-zhen, ZHANG Lan. The predictive value of systemic immune-inflammation index for intravenous immunoglobulin resistance in children with Kawasaki disease[J]. Chinese Journal of General Practice, 2022, 20(11): 1884-1888. doi: 10.16766/j.cnki.issn.1674-4152.002727

系统免疫炎症指数在川崎病IVIG治疗抵抗患儿中的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.002727
基金项目: 

安徽省高等学校省级质量工程重点项目 2021jyxm1760

详细信息
    通讯作者:

    张兰, E-mail: zhanglan1978@ustc.edu.cn

  • 中图分类号: R725.4

The predictive value of systemic immune-inflammation index for intravenous immunoglobulin resistance in children with Kawasaki disease

  • 摘要:   目的  评价系统免疫炎症指数(SII)对于川崎病(KD)患儿静脉注射免疫球蛋白(IVIG)治疗抵抗的预测价值。  方法  回顾性分析2018年1月—2022年3月在中国科学技术大学附属第一医院儿科诊断为KD并接受IVIG治疗的住院患儿445例,依据是否出现IVIG抵抗分为IVIG抵抗组(39例)和IVIG敏感组(406例);再依据血小板值进行分层分析。分别比较各组间炎症指标的差异;针对各差异指标,采用二元logistic回归分析研究其与KD患儿IVIG治疗抵抗的相关性;采用受试者工作特征(ROC)曲线评价各炎性指标预测KD患儿IVIG治疗抵抗的价值。  结果  整体KD患儿样本中,IVIG抵抗组较IVIG敏感组中性粒细胞(N)、中性粒细胞淋巴细胞比率(NLR)、血小板淋巴细胞比率(PLR)、SII、CRP水平高,淋巴细胞(L)较低,差异有统计学意义(均P<0.05);血小板减少KD患儿样本中,各炎症指标数值差异均无统计学意义;非血小板减少KD患儿样本中,IVIG抵抗组较IVIG敏感组N、NLR、SII水平高,差异有统计学意义(均P<0.05)。Logistic回归分析显示,整体样本和非血小板减少KD样本中,NLR与SII均为预测KD患儿IVIG治疗抵抗的因素;ROC曲线分析显示,NLR对于整体KD患儿IVIG抵抗预测敏感度为55%,特异度为67%;SII对于非血小板减少KD患儿IVIG抵抗预测敏感度为56%,特异度为64%。  结论  NLR对于整体KD患儿IVIG抵抗预测能力较强,SII对于非血小板减少KD患儿IVIG抵抗预测能力较强。

     

  • 图  1  SII预测非血小板减少KD患儿IVIG抵抗的ROC曲线

    Figure  1.  ROC curve of SII predicting IVIG resistance in non-thrombocytopenic children with KD

    图  2  SII预测整体KD患儿IVIG抵抗的ROC曲线

    Figure  2.  ROC curve of SII predicting IVIG resistance in overall children with KD

    图  3  NLR预测整体KD患儿IVIG抵抗的ROC曲线

    Figure  3.  ROC curve of NLR predicting IVIG resistance in overall children with KD

    图  4  NLR预测非血小板减少KD患儿IVIG抵抗的ROC曲线

    Figure  4.  ROC curve of NLR predicting IVIG resistance in non-thrombocytopenic children with KD

    表  1  2组KD患儿一般临床资料比较

    Table  1.   Comparison of general clinical data of children with KD between two groups

    组别 例数 年龄[M(P25, P75),岁] 性别(例) 首次IVIG治疗时间(x±s,d) 合并CAL(例)
    IVIG抵抗组 39 1.83(1.00, 2.75) 24 15 6.23±1.46 14 25
    IVIG敏感组 406 1.42(0.71, 2.67) 272 134 6.12±1.28 128 278
    统计量 1.463a 0.133b 0.507c 0.313b
    P 0.143 0.715 0.613 0.576
    注:aZ值,b为χ2值,ct值。
    下载: 导出CSV

    表  2  2组KD患儿炎性指标比较

    Table  2.   Comparison of inflammatory indexes of children with KD between two groups

    组别 例数 WBC [M(P25, P75),×109/L] PLT (x±s,×109/L) N [M(P25, P75),×109/L] L (x±s,×109/L) NLR [M(P25, P75)]
    IVIG抵抗组 39 12.04(9.49, 18.40) 317.93±150.15 10.40(6.39, 12.60) 2.18±1.07 3.68(1.68, 6.16)
    IVIG敏感组 406 12.13(9.23, 16.36) 288.50±143.47 8.70(4.48, 10.96) 3.27±1.72 2.66(1.15, 3.94)
    统计量 0.989a 1.596b 3.056a 2.315b 2.110a
    P 0.324 0.112 0.002 0.021 0.001
    组别 例数 PLR[M(P25, P75)] SII[M(P25, P75)] MPV[M(P25, P75),fL] CRP(x±s,mg/L)
    IVIG抵抗组 39 145.41(101.23,233.22) 1 166.92(638.41, 1 883.65) 9.0(8.4, 9.9) 93.56±4.44
    IVIG敏感组 406 88.07(69.32, 166.51) 737.79(345.18, 1 338.38) 9.1(8.5, 9.7) 72.49±4.02
    统计量 2.332a 3.229a -0.227a 1.408b
    P 0.001 0.025 0.820 0.031
    注:aZ值,bt值。
    下载: 导出CSV

    表  3  2组KD患儿不同PLT分层炎性指标比较[M(P25, P75)]

    Table  3.   Comparison of inflammatory indexes of children with KD between two groups with different platelets stratification [M(P25, P75)]

    组别 例数 血小板减少
    N(×109/L) L(×109/L) NLR PLR SII CRP(mg/L)
    IVIG抵抗组 5 9.50(4.66, 10.12) 2.83(1.79, 3.52) 3.46(2.18, 4.98) 105.14(81.22,252.31) 630.23(338.36, 1 035.05) 73.26(33.96, 147.48)
    IVIG敏感组 48 8.90(5.20, 11.33) 3.09(2.05,4.92) 3.15(2.04, 4.75) 118.12(89.55, 241.09) 621.34(320.27, 1 495.36) 60.39(36.51, 120.17)
    Z -0.863a 1.152a 1.547a -1.088a 2.169a 1.985a
    P 0.121 0.352 0.422 0.285 0.242 0.277
    组别 例数 非血小板减少
    N(×109/L) L(×109/L) NLR PLR SII CRP(mg/L)
    IVIG抵抗组 34 11.02(6.62, 13.11) 3.55±1.18 3.71(1.08, 2.83) 142.38(91.54,356.13) 1 555.30 (478.56, 1 348.89) 87.72±5.08
    IVIG敏感组 358 8.00(4.12, 10.58) 3.70±2.10 2.24(1.62, 2.98) 158.07(89.23, 277.52) 728.88(545.09, 1 529.54) 80.56±3.52
    Z 3.512a 1.908b 1.711a 2.198a 1.766a 2.006b
    P 0.002 0.092 0.001 0.315 0.001 0.099
    注:aZ值,bt值。
    下载: 导出CSV

    表  4  多因素logistic回归分析变量赋值表

    Table  4.   Variable assignment table for multivariate logistic regression analysis

    变量名称 变量赋值临界值 赋值方法
    是否IVIG抵抗 是=1,否=0
    N 1周岁以下或4周岁以上患儿, 是否>6.00×109/L 是=1,否=0
    1~4周岁患儿,是否>4.20×109/L 是=1,否=0
    CRP 是否<8.00 mg/L 是=1,否=0
    L 是否<4.00×109/L 是=1,否=0
    NLR 是否<3.71 是=1,否=0
    PLR 是否<105.66 是=1,否=0
    SII 是否<845.25 是=1,否=0
    下载: 导出CSV

    表  5  KD患儿IVIG治疗抵抗危险因素的多变量logistic回归分析

    Table  5.   Multivariate logistic regression analysis of risk factors for IVIG resistance in children with KD

    PLT分层 变量 B SE Wald χ2 P OR 95% CI
    整体 N 0.751 0.720 1.088 0.410 0.472 0.115~1.935
    L 0.794 1.034 0.590 0.517 2.212 0.292~16.788
    NLR -0.160 0.168 0.907 0.038 0.852 0.613~1.184
    PLR 0.783 1.101 0.506 0.075 2.187 0.253~18.934
    SII -0.341 0.132 6.674 0.035 0.711 0.549~0.921
    CRP 1.180 0.713 2.739 0.181 3.256 0.805~13.164
    非血小板减少 N -0.796 0.723 1.212 0.342 0.451 0.109~1.861
    NLR -0.533 0.263 4.119 0.042 0.587 0.352~0.982
    SII 0.000 0.000 0.464 0.032 1.002 0.987~1.121
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-05-06
  • 网络出版日期:  2022-12-30

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