中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
9期
676-680
,共5页
丙种球蛋白%川崎病%无反应%临床特征%预测
丙種毬蛋白%川崎病%無反應%臨床特徵%預測
병충구단백%천기병%무반응%림상특정%예측
Intravenous immunoglobulin%Kawasaki disease%Unresponsive%Clinical characteristic%Prediction
目的 探讨初始剂量静脉用丙种球蛋白治疗无反应川崎病的临床特征和预测指标.方法 回顾性分析111例确诊为川崎病患儿的临床资料,根据患儿对初始剂量丙种球蛋白治疗的反应,分为敏感组和无反应组,对比2组患儿的临床表现、实验室检查和心脏超声影像学特征,对2组间存在明显差异的指标行Logistic回归分析,确定独立相关因素,并且以丙种球蛋白疗效分组作为标准,以独立相关因素做受试者工作特征(ROC)曲线,观察初始剂量丙种球蛋白治疗无反应的参考指标.结果 1.敏感组90例(81.1％),无反应组21例(18.9％).2.与敏感组比较,无反应组发生超高热和冠状动脉病变的比例明显增高[超高热:66.7％(14/21例)比34.4％(31/90例),x2=7.334,P=0.007;冠状动脉病变:47.6％(10/21例)比23.3％ (21/90例),x2 =4.989,P=0.026].3.丙种球蛋白单次2 g/(kg·d)给药与1 g/(kg·d)分2次给药相比,患儿发生无反应的比例明显降低[12.5％(9/72例)比30.8％(12/39例),x2=5.504,P=0.019],但发生冠状动脉病变无差异[23.6％(17/72例)比30.8％(12/39例),x2=0.672,P=0.412].4.比较2组中性粒细胞比例[(0.72±0.06)比(0.76 ±0.04),t=-2.84,P=0.005]、血小板[(352.38±42.18)×109/L比(373.14±36.93)×109/L,t=-2.076,P=0.040]、C反应蛋白[(74.38±12.92) mg/L比(92.05±11.17) mg/L,t=-5.780,P=0.000]等指标,无反应组均明显高于敏感组,但血清清蛋白明显降低[(34.09±3.19) g/L比(31.61±2.03) g/L,t =4.442,P=0.000].5.多因素Logistic回归分析提示丙种球蛋白治疗无反应的独立危险因素有中性粒细胞比例升高(P=0.018)、C反应蛋白水平升高(P=0.000)和血清清蛋白降低(P=0.040).6.经ROC曲线下面积计算得出中性粒细胞比例、C反应蛋白和血清清蛋白可作为初始剂量丙种球蛋白治疗无反应有价值的预测指标,临界值分别为0.72、78.5 mg/L和33.11 g/L.结论 当川崎病患儿出现以下情形之一:中性粒细胞比例≥0.72、C反应蛋白≥78.5 mg/L或血清清蛋白≤33.11 g/L时,应警惕初始剂量丙种球蛋白治疗可能无反应.
目的 探討初始劑量靜脈用丙種毬蛋白治療無反應川崎病的臨床特徵和預測指標.方法 迴顧性分析111例確診為川崎病患兒的臨床資料,根據患兒對初始劑量丙種毬蛋白治療的反應,分為敏感組和無反應組,對比2組患兒的臨床錶現、實驗室檢查和心髒超聲影像學特徵,對2組間存在明顯差異的指標行Logistic迴歸分析,確定獨立相關因素,併且以丙種毬蛋白療效分組作為標準,以獨立相關因素做受試者工作特徵(ROC)麯線,觀察初始劑量丙種毬蛋白治療無反應的參攷指標.結果 1.敏感組90例(81.1％),無反應組21例(18.9％).2.與敏感組比較,無反應組髮生超高熱和冠狀動脈病變的比例明顯增高[超高熱:66.7％(14/21例)比34.4％(31/90例),x2=7.334,P=0.007;冠狀動脈病變:47.6％(10/21例)比23.3％ (21/90例),x2 =4.989,P=0.026].3.丙種毬蛋白單次2 g/(kg·d)給藥與1 g/(kg·d)分2次給藥相比,患兒髮生無反應的比例明顯降低[12.5％(9/72例)比30.8％(12/39例),x2=5.504,P=0.019],但髮生冠狀動脈病變無差異[23.6％(17/72例)比30.8％(12/39例),x2=0.672,P=0.412].4.比較2組中性粒細胞比例[(0.72±0.06)比(0.76 ±0.04),t=-2.84,P=0.005]、血小闆[(352.38±42.18)×109/L比(373.14±36.93)×109/L,t=-2.076,P=0.040]、C反應蛋白[(74.38±12.92) mg/L比(92.05±11.17) mg/L,t=-5.780,P=0.000]等指標,無反應組均明顯高于敏感組,但血清清蛋白明顯降低[(34.09±3.19) g/L比(31.61±2.03) g/L,t =4.442,P=0.000].5.多因素Logistic迴歸分析提示丙種毬蛋白治療無反應的獨立危險因素有中性粒細胞比例升高(P=0.018)、C反應蛋白水平升高(P=0.000)和血清清蛋白降低(P=0.040).6.經ROC麯線下麵積計算得齣中性粒細胞比例、C反應蛋白和血清清蛋白可作為初始劑量丙種毬蛋白治療無反應有價值的預測指標,臨界值分彆為0.72、78.5 mg/L和33.11 g/L.結論 噹川崎病患兒齣現以下情形之一:中性粒細胞比例≥0.72、C反應蛋白≥78.5 mg/L或血清清蛋白≤33.11 g/L時,應警惕初始劑量丙種毬蛋白治療可能無反應.
목적 탐토초시제량정맥용병충구단백치료무반응천기병적림상특정화예측지표.방법 회고성분석111례학진위천기병환인적림상자료,근거환인대초시제량병충구단백치료적반응,분위민감조화무반응조,대비2조환인적림상표현、실험실검사화심장초성영상학특정,대2조간존재명현차이적지표행Logistic회귀분석,학정독립상관인소,병차이병충구단백료효분조작위표준,이독립상관인소주수시자공작특정(ROC)곡선,관찰초시제량병충구단백치료무반응적삼고지표.결과 1.민감조90례(81.1％),무반응조21례(18.9％).2.여민감조비교,무반응조발생초고열화관상동맥병변적비례명현증고[초고열:66.7％(14/21례)비34.4％(31/90례),x2=7.334,P=0.007;관상동맥병변:47.6％(10/21례)비23.3％ (21/90례),x2 =4.989,P=0.026].3.병충구단백단차2 g/(kg·d)급약여1 g/(kg·d)분2차급약상비,환인발생무반응적비례명현강저[12.5％(9/72례)비30.8％(12/39례),x2=5.504,P=0.019],단발생관상동맥병변무차이[23.6％(17/72례)비30.8％(12/39례),x2=0.672,P=0.412].4.비교2조중성립세포비례[(0.72±0.06)비(0.76 ±0.04),t=-2.84,P=0.005]、혈소판[(352.38±42.18)×109/L비(373.14±36.93)×109/L,t=-2.076,P=0.040]、C반응단백[(74.38±12.92) mg/L비(92.05±11.17) mg/L,t=-5.780,P=0.000]등지표,무반응조균명현고우민감조,단혈청청단백명현강저[(34.09±3.19) g/L비(31.61±2.03) g/L,t =4.442,P=0.000].5.다인소Logistic회귀분석제시병충구단백치료무반응적독립위험인소유중성립세포비례승고(P=0.018)、C반응단백수평승고(P=0.000)화혈청청단백강저(P=0.040).6.경ROC곡선하면적계산득출중성립세포비례、C반응단백화혈청청단백가작위초시제량병충구단백치료무반응유개치적예측지표,림계치분별위0.72、78.5 mg/L화33.11 g/L.결론 당천기병환인출현이하정형지일:중성립세포비례≥0.72、C반응단백≥78.5 mg/L혹혈청청단백≤33.11 g/L시,응경척초시제량병충구단백치료가능무반응.
Objective To determine the prediction and clinical characteristics of intravenous immunoglobulin (IVIG) treated Kawasaki disease (KD) failure in initial dose.Methods Retrospective analysis was performed with the clinical data of 1 11 children with KD.The paticnts were divided into sensitive group and unresponsive group according to initial effect of IVIG.The clinical manifestations,laboratory examination and radiological features of the children were compared.Logistic regression analysis was performed in significant different indicators to determine independent correlation factors.In order to seek the reference indexes which indicate unresponsive to IVIG,a receiver operating characteristic (ROC) curve was made,of which the diagnostic cut-off was nine independent correlation factors while grouping was made according to patients' different responses to IVIG.Results (1)There were 90 cases (81.1％)in effective group and 21 cases (18.9％) in unresponsive group.(2) Compared with the sensitive group,hyperpyrexia cases[66.7％ (14/ 21 cases) vs 34.4％ (31/90 cases),x2 =7.334,P =0.007] and the chances of coronary artery lesions [47.6％ (10/ 21 cases) vs 23.3％ (21/90 cases),x2 =4.989,P =0.026] were significantly higher in the unresponsive group.(3)Compared with the children administered twice with gamma globulin,the children of single-dose treatment significantly reduced the unresponsive probability [12.5 ％ (9/72 cases) vs 30.8 ％ (12/39 cases),x2 =5.504,P =0.019],and there was no difference in the chances of coronary artery lesions[23.6％ (17/72 cases) vs 30.8％ (12/39 cases),x2 =0.672,P =0.412].(4)Comparing the sensitive group and the unresponsive group,the percentage of neutrophils count [(0.72 ± 0.06) vs (0.76 ± 0.04),t =-2.84,P =0.005],platelet counts [(352.38 ± 42.18) × 109/L vs (373.14 ±36.93) × 109/L,t =-2.076,P =0.040] and C-reactive protein (CRP) [(74.38 ± 12.92) mg/L vs (92.05 ± 11.17) mg/L,t =-5.780,P =0.000] were significantly higher in the unresponsive group,but the level of serum albumin[(34.09 ±3.19) g/L vs (31.61 ±2.03) g/L,t =4.442,P =0.000] was lower.(5) Multivariate Logistic regression analysis indicated that the percentage increase of neutrophils count (P =0.018),CRP (P =0.000) increase and serum albumin(P =0.040) decrease were independent risk factors for unresponsive treatment with gamma globulin.(6)After the area under the ROC curve was calculated,the percentage of neutrophils count,CRP and serum albumin could be effective predictors to IVIG treatment failure in initial dose,and the critical values were 0.72,78.5 mg/L and 33.11 g/L,respectively.Conclusions Treatment with IVIG for the first time may be ineffective in some situations such as the percentage of neutrophils count ≥0.72,CRP ≥78.5 mg/L or serum albumin≤33.11 g/L.
