Predictors for intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease.
Predictors for intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease.
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川崎病静脉注射免疫球蛋白抵抗和冠状动脉病变的预测因素
DOI：
10.1186/s12969-017-0149-1
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发表时间：
2017-03-21
期刊：
影响因子：
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通讯作者：
Gong F
中科院分区：
文献类型：
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作者：
Xie T;Wang Y;Fu S;Wang W;Xie C;Zhang Y;Gong F
背景：探讨川崎病（KD）患者静脉注射免疫球蛋白（IVIG）抵抗和冠状动脉病变（CALs）的预测因素。方法回顾性分析560例KD患者，包括410例完全KD （cKD）和150例不完全KD （iKD）。比较了抗ivig组和抗ivig组、冠状动脉病变组（CALs+）和无冠状动脉病变组（CALs-）的实验室数据。结果在cKD患者中，c反应蛋白（CRP）水平预测ivig耐药的敏感性为65.52%，特异性为62.7%，临界值为100 mg/L。当白蛋白<32 g/L时，预测ivig耐药的敏感性为72%，特异性为83.19%。n端前脑利钠肽（NT-proBNP）水平预测ivig耐药的敏感性为73.91%，特异性为76.43%，临界值为bbb1300pg /ml。白细胞介素-6的敏感性为76.19%，特异性为61.59%，临界值为45pg /ml。红细胞沉降率（ESR）水平预测CALs的敏感性为53.26%，特异性为64.14%，临界值为bbb75 mm/h。在iKD患者中，当血红蛋白<110 g/L时，预测ivig耐药的敏感性为80%，特异性为54.1%。当中性粒细胞比例为70%时，预测耐药的敏感性为68%，特异性为66.94%。ESR水平预测ivig耐药的敏感性为70.83%，特异性为65.81%，临界值为bbb80 mm/h。NT-proBNP水平预测ivig耐药的敏感性为78.57%，特异性为56.67%，临界值为bb0 360 pg/ml。白细胞介素-6水平的敏感性为70.59%，特异性为66.28%，临界值为>25 pg/ml。白细胞介素-10水平预测ivig耐药的敏感性为64.71%，特异性为74.42%，临界值为>.8 pg/ml。ESR水平预测CALs的灵敏度为61.82%，特异性为65.12%，临界值为bbb75 mm/h。结论白细胞计数、中性粒细胞比例、血红蛋白、CRP、ESR、白蛋白、NT-proBNP、白细胞介素6和10可能是预测KD患者IVIG耐药和CALs的有效指标。
BackgroundTo assess the predictors for intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in Kawasaki disease (KD).MethodsA total of 560 KD patients were reviewed retrospectively, including 410 complete KD (cKD) and 150 incomplete KD (iKD) patients. The laboratory data were compared between the IVIG-resistant and IVIG-responsive groups, as well as between the coronary artery lesions (CALs+) and without coronary artery lesions (CALs-) groups.ResultsIn the cKD patients, C-reactive protein (CRP) levels had a sensitivity of 65.52% and a specificity of 62.7% for predicting IVIG-resistance at a cutoff point of >100 mg/L. When albumin <32 g/L, the sensitivity and specificity for predicting IVIG-resistance were 72 and 83.19%, respectively. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels had a sensitivity of 73.91% and a specificity of 76.43% for predicting IVIG-resistance at a cutoff point of >1300 pg/ml. Interleukin-6 levels had a sensitivity of 76.19% and a specificity of 61.59% at a cutoff value of >45 pg/ml. Erythrocyte sedimentation rate (ESR) levels had a sensitivity of 53.26% and a specificity of 64.14% for predicting CALs at a cutoff point of >75 mm/h.In the iKD patients, the sensitivity and specificity for predicting IVIG-resistance were 80 and 54.1% when hemoglobin <110 g/L. When proportion of neutrophils >70%, the sensitivity and specificity for predicting IVIG-resistance were 68 and 66.94%, respectively. ESR levels had a sensitivity of 70.83% and a specificity of 65.81% for predicting IVIG-resistance at a cutoff point of >80 mm/h. NT-proBNP levels had a sensitivity of 78.57% and a specificity of 56.67% for predicting IVIG-resistance at a cutoff point of >360 pg/ml. Interleukin-6 levels had a sensitivity of 70.59% and a specificity of 66.28% at a cutoff value of >25 pg/ml. Interleukin-10 levels had a sensitivity of 64.71% and a specificity of 74.42% for predicting IVIG-resistance at a cutoff value of >8 pg/ml. ESR levels had a sensitivity of 61.82% and a specificity of 65.12% for predicting CALs at a cutoff point of >75 mm/h.ConclusionsThe white blood cell count, proportion of neutrophils, hemoglobin, CRP, ESR, albumin, NT-proBNP, interleukin-6 and 10 may be effective predictors for IVIG resistance and CALs in KD patients.