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

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

储安贞,
张兰^,

中国科学技术大学附属第一医院儿科，安徽合肥 230001

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
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出版历程
- 收稿日期: 2022-05-06
- 网络出版日期: 2022-12-30

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

CHU An-zhen,
ZHANG Lan^,

Department of Pediatrics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, China

摘要

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。
- 川崎病 /
- 系统免疫炎症指数 /
- 静脉注射免疫球蛋白抵抗 /
- 血小板
Abstract: Objective To evaluate the predictive value of systemic immune-inflammation index (SII) for intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD). Methods A total of 445 hospitalized children diagnosed with KD and treated with IVIG in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to March 2022 were retrospectively analyzed. According to the presence of IVIG resistance, they were divided into IVIG resistance group and IVIG sensitive group. Stratified analysis was performed according to platelet value. The differences of inflammatory indexes between each group were compared and binary logistic regression was used to analyze the correlation between each inflammatory index and IVIG-resistance in children with KD. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each inflammatory index for IVIG-resistance in children with KD. Results For all children with KD, inflammatory indexes including N, NLR, PLR, SII, and CRP of the IVIG-resistant group were higher than those of the IVIG-sensitive group (all P < 0.05), and L was lower (P < 0.05). For thrombocytopenia KD children, there was no statistical difference in the values of each inflammatory indexes. For non-thrombocytopenia KD children, the levels of N, NLR and SII of the IVIG-resistant group were higher than those of the IVIG-sensitive group (all P < 0.05). Logistic regression analysis showed that both NLR and SII were independent risk factors for predicting IVIG resistance. ROC curve analysis showed that the sensitivity of NLR for predicting IVIG-resistance in allover the KD children was 55%, and the specificity was 67%. The sensitivity of SII for predicting IVIG-resistance in non-thrombocytopenic KD children was 56%, and the specificity was 64%. Conclusion NLR has a strong predictive ability for IVIG-resistance in allover children with KD, and SII has a strong predictive ability for IVIG-resistance in non-thrombocytopenic KD children.
- Kawasaki disease /
- Systemic immune-inflammation index /
- Intravenous immunoglobulin resistance /
- Platelets

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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

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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

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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

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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

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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)
组别	例数	年龄[M(P₂₅, P₇₅)，岁]	男	女	首次IVIG治疗时间(x±s，d)	是	否
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		1.463^a	0.133^b		0.507^c	0.313^b
P值		0.143	0.715		0.613	0.576
注：^a为Z值，^b为χ²值，^c为t值。

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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		0.989^a	1.596^b	3.056^a	2.315^b	2.110^a
P值		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		2.332^a	3.229^a		-0.227^a	1.408^b
P值		0.001	0.025		0.820	0.031
注：^a为Z值，^b为t值。

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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
组别	例数	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值		-0.863^a	1.152^a	1.547^a	-1.088^a	2.169^a	1.985^a
P值		0.121	0.352	0.422	0.285	0.242	0.277

组别	例数	非血小板减少
组别	例数	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值		3.512^a	1.908^b	1.711^a	2.198^a	1.766^a	2.006^b
P值		0.002	0.092	0.001	0.315	0.001	0.099
注：^a为Z值，^b为t值。

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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

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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值	OR值	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

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