Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease
Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease
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DOI：
10.1016/j.jpeds.2006.03.050
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发表时间：
2006-08-01
影响因子：
5.1
通讯作者：
Matsuishi, Toyojiro
中科院分区：
文献类型：
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作者：
Egami, Kimiyasu;Muta, Hiromi;Matsuishi, Toyojiro
目的 本研究的目的是寻找川崎病 (KD) 患者静脉注射免疫球蛋白 (IVIG) 耐药性的预测因子并生成预测评分。 研究设计 诊断为川崎病的患者在患病 9 天内接受初始高剂量 IVIG 治疗（2 g/kg 剂量）时进行采样（n = 320）。这些患者被分为 2 组：耐药组 (n = 41) 和应答组 (n = 279)。获得以下数据并在耐药者和应答者之间进行比较：年龄、性别、初始治疗时的患病天数和实验室数据。结果多变量逻辑回归分析确定年龄、患病天数、血小板计数、丙氨酸转氨酶 (ALT) 和 C 反应蛋白 (CRP) 是 IVIG 耐药性的重要预测因子。我们生成了预测评分，为 (1) 小于 6 个月大的婴儿、(2) 患病 4 天之前、(3) 血小板计数 = 8 mg/dL 以及 (5) ALT >= 80 IU/L 分配 2 分。使用此预测评分的 3 或更高的截止点，我们可以以 78% 的敏感性和 76% 的特异性来识别 IVIG 耐药组。 结论 可以使用年龄、患病天数、血小板来预测对 IVIG 治疗的耐药性。计数、ALT 和 CRP。随机、多中心临床试验对于制定治疗这些高危患者的新策略是必要的。
Objectives The objective of this study was to find the predictors and generate a prediction score of resistance to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD).Study design Patients diagnosed as having KD were sampled when they received initial high-dose IVIG treatment (2 g/kg dose) within 9 days of illness (n = 320). These patients were divided into 2 groups: the resistance (n = 41) and the responder (n = 279). The following data were obtained and compared between resistance and responder: age, sex, illness days at initial treatment, and laboratory data.Results Multivariate logistic regression analysis identified age, illness days, platelet count, alanine aminotransferase (ALT), and C-reactive protein (CRP) as significant predictors for resistance to IVIG. We generated prediction score assigning I point for (1) infants less than 6 months old, (2) before 4 days of illness, (3) platelet count = 8 mg/dL, as well as 2 points for (5) ALT >= 80 IU/L. Using a cut-off point of 3 and more with this prediction score, we could identify the IVIG-resistant group with 78% sensitivity and 76% specificity.Conclusions Resistance to IVIG treatment can be predicted using age, illness days, platelet. count, ALT, and CRP. Randomized, multicenter clinical trials are necessary to create a new strategy to treat these high-risk patients.