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中华诊断学电子杂志 ›› 2025, Vol. 13 ›› Issue (01) : 51 -58. doi: 10.3877/cma.j.issn.2095-655X.2025.01.008

临床研究

超声心动图联合实验室检查预测静脉注射丙种球蛋白无反应性川崎病的价值
文杨1, 刘健2,†(), 姚海波3, 金梅1, 杨胜1, 马荣川1   
  1. 1. 611731 成都,电子科技大学医学院附属妇女儿童医院(成都市妇女儿童中心医院)超声影像科
    2. 610500 成都医学院第一附属医院超声科
    3. 611731 成都,电子科技大学医学院附属妇女儿童医院(成都市妇女儿童中心医院)病案统计科
  • 收稿日期:2024-11-04 出版日期:2025-02-26
  • 通信作者: 刘健
  • 基金资助:
    成都市卫健委科研项目(2021131)

The value of echocardiography combined with laboratory examination in predicting intravenous immunoglobulin unresponsive Kawasaki disease

Yang Wen1, Jian Liu2,†(), Haibo Yao3, Mei Jin1, Sheng Yang1, Rongchuan1 Ma1   

  1. 1. Department of Ultrasound, Chengdu Women's and Children's Central Hospital (School of Medicine, University of Electronic Science and Technology of China), Chengdu 611731,China
    2. Department of Ultrasound, the First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
    3. Department of Medical Records and Statistics, Chengdu Women's and Children's Central Hospital (School of Medicine, University of Electronic Science and Technology of China), Chengdu 611731,China
  • Received:2024-11-04 Published:2025-02-26
  • Corresponding author: Jian Liu
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引用本文：

文杨, 刘健, 姚海波, 金梅, 杨胜, 马荣川. 超声心动图联合实验室检查预测静脉注射丙种球蛋白无反应性川崎病的价值[J/OL]. 中华诊断学电子杂志, 2025, 13(01): 51-58.

Yang Wen, Jian Liu, Haibo Yao, Mei Jin, Sheng Yang, Rongchuan1 Ma. The value of echocardiography combined with laboratory examination in predicting intravenous immunoglobulin unresponsive Kawasaki disease[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(01): 51-58.

目的

探讨超声心动图(UCG)联合实验室检查在预测静脉注射丙种球蛋白(IVIG)治疗无反应性川崎病(KD)中的应用价值。

方法

收集2019 年9 月至2023 年9 月成都市妇女儿童中心医院儿童心脏内科收治的164 例KD 患儿,依据对IVIG 治疗的敏感情况,分为IVIG 无反应组(n=82)和IVIG 反应组(n=82)。 比较两组治疗前UCG 表现、实验室检查指标,并采用多因素Logistic 回归预测发生IVIG 无反应的高危因素,绘制受试者操作特征(ROC)曲线,评价预测效能。

结果

IVIG无反应组冠状动脉(CA)扩张比例比IVIG 反应组更高[37.80%(31/82),20.73%(17/82)],差异有统计学意义(χ2 =5.773,P=0.016)。 三尖瓣反流(TR)、丙氨酸氨基转氨酶(ALT)>40 U/L、白蛋白(ALB)<35 g/L、D-二聚体(D-Dimer)>0.5 mg/L、中性粒细胞与淋巴细胞计数比值(NLR)>1.29、血小板(PLT)>420×109/L、血小板与淋巴细胞计数比值(PLR)>126.8 是发生IVIG 无反应的独立危险因素[OR=19.136(95%CI:3.634~100.756),1.016(95%CI:1.007~1.025),0.912(95%CI:0.835~0.996),1.780(95%CI:1.091~2.904),0.812(95%CI:0.681~0.969),1.014(95%CI:1.007~1.022),1.022(95%CI:1.006~1.037);均P<0.05]。 双联合中TR 联合PLT 的ROC 曲线下面积为0.850,敏感度为63.41%,特异度为95.12%;三联合中TR 联合ALT 及PLT 的ROC 曲线下面积为0.903,敏感度为80.49%,特异度为86.59%;多联合中TR 联合ALT、PLT、ALB、D-Dimer 及PLR 共6 项指标的ROC 曲线下面积为0.946,敏感度为86.59%,特异度为92.68%。

结论

KD 患儿CA 扩张、TR、ALT水平升高、ALB 降低、D-Dimer 升高、NLR 升高、PLT 升高、PLR 升高、血沉升高等是发生IVIG 无反应的高危因素。 UCG 联合实验室检查可为预测IVIG 无反应发生提供更准确的价值。

关键词: 川崎病, 丙种球蛋白, 无反应, 超声心动图, 危险因素

Objective

To investigate the application value of echocardiography (UCG) combined with laboratory examination in predicting unresponsive Kawasaki disease (KD) intravenous immunoglobulin(IVIG) treatment.

Methods

The data of total of 164 children with KD admitted to the Children′s Cardiography Department of Chengdu Women and Children′s Central Hospital from September 2019 to September 2023 were collected.According to the sensitivity to IVIG treatment, the children were divided into the IVIG nonresponse group (n=82) and the IVIG response group (n=82). The UCG performance and laboratory examination indexes before treatment were compared between the two groups. Multivariate Logistic regression was used to predict the risk factors for IVIG non-response, and receiver operating characteristic (ROC)curve was drawn to evaluate the prediction efficacy.

Results

The proportion of coronary artery (CA)dilation in the IVIG non-response group was higher than that in the IVIG response group [37.80%(31/82),20.73%(17/82)], and the difference was statistically significant (χ2 = 5.773, P= 0.016). Tricuspid regurgitation (TR), alanine aminotransferase (ALT)>40 U/L, albumin (ALB)<35 g/L, D-Dimer>0.5 mg/L, neutrophil to lymphocyte ratio (NLR) >1.29, platelet (PLT) >420×109/L, platelet and lymphocyte ratio (PLR)>126.8 were independent risks factors for IVIG non-response [OR=19.136(95%CI: 3.634-100.756),1.016(95%CI:1.007-1.025),0.912(95%CI:0.835-0.996),1.780(95%CI:1.091-2.904),0.812(95%CI:0.681-0.969),1.014(95%CI:1.007-1.022),1.022(95%CI:1.006-1.037), all P<0.05]. The area under the ROC curve of TR combined with PLT was 0.850, the sensitivity was 63.41%, and the specificity was 95.12%. The area under the ROC curve of TR combined with ALT and PLT was 0.903, the sensitivity was 80.49%, and the specificity was 86.59%. The area under the ROC curve of TR combined with ALT, PLT, ALB, D-Dimer and PLR was 0.946, the sensitivity was 86.59%,and the specificity was 92.68%.

Conclusions

CA dilation, TR, ALT elevation, ALB reduction, D-Dimer elevation, NLR elevation, PLT elevation, PLR elevation, erythrocyte sedimentation rate elevation are highrisk factors for IVIG non-response in KD patients. UCG combined with laboratory testing provide a more accurate method for predicting IVIG non-response.

Key words: Kawasaki disease, Gamma globulin, No response, Ultrasonocardiography, Risk factor
表1 164 例川崎病患儿超声心动图情况(例)
项目 总例数 IVIG无反应 IVIG反应
巨大CAA 4 3 1
中等CAA 3 3 0
小CAA或扩张 41 25 16
LV增大 8 5 3
LA增大 6 3 3
TR 54 34 20
MR 35 16 19
心包积液 6 4 2
表2 KD 患儿IVIG 反应组与无反应组治疗前实验室及超声心动图指标比较
项目 IVIG反应组(n=82) IVIG无反应组(n=82) 统计量 P值
年龄[月,M(Q1,Q3)] 24.00(12.00,48.00) 30.00(12.00,48.00) Z=0.390 0.998
性别(男/女,例) 49/33 55/27 χ 2=0.946 0.331
LA前后径[mm,M(Q1,Q3)] 31.00(28.00,32.00) 31.00(29.00,32.00) Z=0.937 0.344
LV前后径[mm,M(Q1,Q3)] 13.50(12.00,15.00) 13.00(12.00,15.00) Z=0.390 0.998
LVEF[%,M(Q1,Q3)] 68.00(66.00,70.00) 68.00(66.00,70.00) Z=0.156 1.000
LMCA扩张[例(%)] 9(10.98) 17(20.73) χ 2=2.925 0.087
LMCA扩张[M(Q1,Q3)] 0.56(0.03,1.21) 1.22(0.91,2.15) Z=2.925 0.087
LDA扩张[例(%)] 8(9.76) 17(20.73) χ 2=3.823 0.051
LDA扩张[M(Q1,Q3)] 0.32(-0.13,0.94) 1.03(0.39,1.47) Z=3.823 0.051
LCX扩张[例(%)] 0 3(3.66) χ 2=3.056 0.080
RCA扩张[例(%)] 7(8.54) 17(20.73) χ 2=4.881 0.027
RCA扩张[M(Q1,Q3)] 0.45(0.12,0.93) 1.25(0.36,1.98) χ 2=4.881 0.027
RCA扩张中段[例(%)] 1(1.22) 7(8.54) χ 2=3.285 0.070
RCA扩张中段[M(Q1,Q3)] 0.45(0.12,0.93) 0.88(0.39,1.36) Z=3.285 0.070
冠脉扩张[例(%)] 17(20.73) 31(37.80) χ 2=5.773 0.016
心包积液[例(%)] 2(2.44) 4(4.88) χ 2=0.692 0.405
MR[例(%)] 19(23.17) 16(19.51) χ 2=0.327 0.567
TR[例(%)] 20(24.39) 34(41.46) χ 2=5.411 0.020
冠脉管壁毛糙[例(%)] 30(36.59) 32(39.02) χ 2=0.104 0.747
ALT＞40U/L[例(%)] 26(31.71) 56(68.29) χ 2=21.951 0.000
ALB＜35g/L[例(%)] 26(31.71) 57(69.51) χ 2=23.443 0.000
D-Dimer＞0.5mg/L[例(%)] 29(35.37) 48(58.54) χ 2=8.838 0.003
NEU＞6.03×109/L[例(%)] 59(71.95) 65(79.27) χ 2=1.190 0.275
NLR＞1.29[例(%)] 64(78.05) 74(90.24) χ 2=4.571 0.033
CRP＞10mg/L[例(%)] 76(92.68) 76(92.68) χ 2=0.000 1.000
WBC＞11.09×109/L[例(%)] 58(70.73) 60(73.17) χ 2=0.121 0.728
LY(＜0.98或＞7.5)×109/L[例(%)] 6(7.32) 6(7.32) χ 2=0.000 1.000
PLT＞420×109/L[例(%)] 3(3.66) 32(39.02) χ 2=30.548 0.000
PLR＞126.8[例(%)] 16(19.51) 48(58.54) χ 2=26.240 0.000
ESR＞15mm/h[例(%)] 73(89.02) 62(75.61) χ 2=5.069 0.024
表3 KD 患儿IVIG 无反应的多因素Logistic 回归分析
因素 B SE Wald χ 2值 P值 OR值(95%CI)
冠脉扩张 -1.278 0.709 3.254 0.071 0.279(0.069~1.117)
RCA扩张 0.177 1.060 0.028 0.867 1.194(0.150~9.528)
TR 2.952 0.848 12.128 0.001 19.136(3.634~100.756)
ALT＞40U/L 0.016 0.004 12.419 0.001 1.016(1.007~1.025)
ALB＜35g/L -0.092 0.045 4.211 0.040 0.912(0.835~0.996)
D-Dimer>0.5mg/L 0.577 0.250 5.329 0.021 1.780(1.091~2.904)
NLR＞1.29 -0.208 0.090 5.350 0.001 0.812(0.681~0.969)
PLT＞420×109/L 0.014 0.004 13.501 0.005 1.014(1.007~1.022)
PLR＞126.8 0.022 0.008 7.738 0.027 1.022(1.006~1.037)
ESR＞15mm/h -0.013 0.008 2.346 0.126 0.987(0.971~1.004)
图1 预测KD 患儿IVIG 无反应高危因素的ROC 曲线 注:a 图为实验室指标预测IVIG 无反应的ROC 曲线;b图为超声心动图指标预测IVIG 无反应的ROC 曲线;ROC 为受试者操作特征;RCA 为右冠状动脉;TR 为三尖瓣反流;NLR 为中性粒细胞与淋巴细胞计数比值;PLR 为血小板与淋巴细胞计数比值;KD 为川崎病;IVIG 为静脉注射丙种球蛋白
表4 KD 患儿IVIG 无反应的ROC 曲线分析
指标 AUC(95%CI) P值 敏感度(%) 特异度(%)
冠脉扩张 0.546(0.466~0.624) 0.312 41.46 75.61
RCA扩张 0.580(0.501~0.657) 0.073 37.80 82.93
TR 0.585(0.506~0.662) 0.019 75.61 41.46
ALT＞40U/L 0.693(0.616~0.763) 0.000 71.95 67.07
ALB＜35g/L 0.683(0.606~0.754) 0.000 64.63 68.29
D-Dimer＞0.5mg/L 0.637(0.559~0.711) 0.000 48.78 79.27
NLR＞1.29 0.547(0.467~0.624) 0.302 92.68 19.51
PLT＞420×109/L 0.852(0.788~0.903) 0.000 93.90 62.20
PLR＞126.8 0.752(0.679~0.816) 0.000 85.37 57.32
图2 TR 联合ALT、ALB、D-Dimer、PLT、PLR 预测KD患儿IVIG 无反应的ROC 曲线 注:ROC 为受试者操作特征;AUC 为曲线下面积;TR 为三尖瓣反流;ALT 为丙氨酸氨基转移酶;ALB 为白蛋白;DDimer 为D-二聚体;PLT 为血小板;PLR 为血小板与淋巴细胞计数比值;KD 为川崎病;IVIG 为静脉注射丙种球蛋白
表5 TR 联合实验室指标预测KD 患儿IVIG无反应的ROC 曲线分析
指标 AUC(95%CI) P值 敏感度(%) 特异度(%)
TR-ALT 0.745(0.671~0.810) ＜0.01 63.41 82.93
TR-ALB 0.715(0.639~0.782) ＜0.01 59.76 79.27
TR-D-Dimer 0.669(0.592~0.741) ＜0.01 90.24 35.37
TR-PLT 0.850(0.786~0.901) ＜0.01 63.41 95.12
TR-PLR 0.766(0.694~0.829) ＜0.01 76.83 70.73
TR-ALT-ALB 0.748(0.674~0.812) ＜0.01 64.63 76.83
TR-ALT-PLR 0.821(0.754~0.877) ＜0.01 84.15 69.51
TR-ALT-D-Dimer 0.763(0.691~0.826) ＜0.01 68.29 75.61
TR-ALT-PLT 0.903(0.847~0.943) ＜0.01 80.49 86.59
TR-ALB-D-Dimer 0.735(0.661~0.801) ＜0.01 69.51 73.17
TR-ALB-PLT 0.886(0.827~0.930) ＜0.01 69.51 95.12
TR-ALB-PLR 0.814(0.746~0.870) ＜0.01 79.27 74.39
TR-D-Dimer-PLT 0.878(0.818~0.924) ＜0.01 75.61 90.24
TR-D-Dimer-PLR 0.800(0.731~0.859) ＜0.01 68.29 80.49
TR-PLT-PLR 0.877(0.817~0.923) ＜0.01 67.07 97.56
TR-ALT、ALB、D-Dimer、PLT及PLR 0.946(0.899~0.975) ＜0.01 86.59 92.68
[1]
Newburger JW,Takahashi M,Burns JC. Kawasaki Disease[J]. J Am Coll Cardiol,2016,67(14):1738-1749. DOI:10. 1016/j.jacc.2015.12.073.
[2]
中华医学会儿科学分会心血管学组,中华医学会儿科学分会风湿学组,中华医学会儿科学分会免疫学组,等. 川崎病诊断和急性期治疗专家共识[J]. 中华儿科杂志,2022,60(1):6-13.DOI:10.3760/cma.j.cn112140-20211018-00879.
[3]
McCrindle BW,Rowley AH,Newburger JW,et al.Diagnosis,treatment,and long-term management of kawasaki disease:a scientific statement for health professionals from the American Heart Association[J].Circulation,2017,135(17):e927-e999. DOI:10. 1161/CIR.0000000000000484.
[4]
林瑶,李晓惠,石琳,等.2017 年版《川崎病的诊断、治疗及远期管理-美国心脏协会对医疗专业人员的科学声明》解读[J].中国实用儿科杂志,2017,32(9):641-648. DOI:10. 19538/j.ek2017090601.
[5]
Maccora I,Calabri GB,Favilli S,et al.Long-term follow-up of coronary artery lesions in children in Kawasaki syndrome[J].Eur J Pediatr,2021,180(1):271-275.DOI:10.1007/s00431-020-03712-6.
[6]
王雷,夏焙.超声心动图在川崎病诊断、治疗及长期随访中的应用进展-2017 年AHA 指南的解读[J/CD]. 中华医学超声杂志(电子版),2019,16(3):161-165.DOI:10.3877/cma.j. issn.1672-6448.2019.03.001.
[7]
张清友,简佩君,杜军保. 风湿热、心内膜炎及川崎病委员会,美国心脏病学会及美国儿科学会川崎病的诊断、治疗及长期随访指南介绍[J]. 实用儿科临床杂志,2012,27(13):1049-1056.DOI:10.3969/j.issn.1003-515X.2012.13.029.
[8]
Angkananard T,Anothaisintawee T,McEvoy M,et al. Neutrophil lymphocyte ratio and cardiovascular disease risk: a systematic review and meta-analysis[J]. Biomed Res Int,2018(2018):2703518.DOI:10.1155/2018/2703518.
[9]
袁迎第,孙军,李鹏飞,等.中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值对于川崎病IVIG 敏感性的预测价值[J].中国当代儿科杂志,2017,19(4):410-413. DOI:10. 7499/j.issn.1008-8830.2017.04.010.
[10]
Qian W, Tang Y, Yan W, et al. A comparison of efficacy of six prediction models for intravenous immunoglobulin resistance in Kawasaki disease[J]. Ital J Pediatr,2018,44(1):33. DOI:10.1186/s13052-018-0475-z.
[11]
Lopez L,Colan S,Stylianou M,et al. Relationship of echocardiographic Z scores adjusted for body surface area to age,sex,race,and ethnicity:the pediatric heart network normal echocardiogram database[J]. Circ Cardiovasc Imaging,2017,10(11):e006979.DOI:10.1161/CIRCIMAGING.117.006979.
[12]
中华医学会儿科学分会心血管学组,中华儿科杂志编辑委员会.川崎病冠状动脉病变的临床处理建议(2020 年修订版)[J].中华儿科杂志,2020,58(9):718-724. DOI:10. 3760/cma.j.cn112140-20200422-00421.
[13]
夏焙,许娜,何学智,等.儿童超声心动图冠状动脉正常参考值及临床意义[J/CD].中华医学超声杂志(电子版),2013,(1):42-51.
[14]
Friedman KG,Gauvreau K,Hamaoka-Okamoto A,et al. Coronary artery aneurysms in Kawasaki disease:risk factors for progressive disease and adverse cardiac events in the US population[J].J Am Heart Assoc,2016,5(9):e003289. DOI:10. 1161/JAHA. 116.003289.
[15]
Burns JC,Hoshino S,Kobayashi T. Kawasaki disease:an essential comparison of coronary artery aneurysm criteria[J]. Lancet Child Adolesc Health,2018,2(12):840-841. DOI:10. 1016/S2352-4642(18)30334-1.
[16]
牛超,王琳琳,贾尝,等.川崎病发生机制研究[J].中国小儿急救医学,2020,27(9):645-649.DOI:10.3760/cma.j. issn.1673-4912.2020.09.002.
[17]
鲁炜慧,杜忠东,赵地,等.基于北京市儿童川崎病6 年流行病学资料的实验室指标分析[J]. 中国循证儿科杂志,2008,3(5):356-361.DOI:10.3969/j.issn.1673-5501.2008.05.007.
[18]
陈芃螈,杨超,李刚,等.系统性免疫-炎症指数对川崎病患儿冠脉扩张的预测价值[J].中国免疫学杂志,2020,36(16):2003-2006.DOI:10.3969/j.issn.1000-484X.2020.16.017.
[19]
王程浩,刘芳. 川崎病所致冠状动脉病变的病理改变及结局[J].中华实用儿科临床杂志,2021,36(22):1757-1760.DOI:10.3760/cma.j.cn101070-20210510-00513.
[20]
乐园,刘桂英,赵梓文. 静脉注射免疫球蛋白无反应性川崎病的危险因素分析[J]. 中国医药,2018,13(4):582-586. DOI:10.3760/cma.j.issn.1673-4777.2018.04.026.
[21]
Yan Y,Qiao L,Hua Y,et al.Predictive value of Albumin-Bilirubin grade for intravenous immunoglobulin resistance in a large cohort of patients with Kawasaki disease:a prospective study[J]. Pediatr Rheumatol Online J,2021,19(1):147. DOI:10. 1186/s12969-021-00638-7.
[22]
Li X,Chen Y,Tang Y,et al.Predictors of intravenous immunoglobulinresistant Kawasaki disease in children:a meta-analysis of 4 442 cases[J]. Eur J Pediatr,2018,177(8):1279-1292. DOI:10.1007/s00431-018-3182-2.
[23]
Muto T,Masuda Y,Numoto S,et al.White blood cell and neutrophil counts and response to intravenous immunoglobulin in kawasaki disease[J].Glob Pediatr Health,2019(6):2333794X19884826.DOI:10.1177/2333794X19884826.
[24]
Kurtul A, Acikgoz SK. Usefulness of mean platelet volume-tolymphocyte ratio for predicting angiographic no-reflow and shortterm prognosis after primary percutaneous coronary intervention in patients with ST-Segment elevation myocardial infarction[J].Am J Cardiol,2017,120(4):534-541. DOI:10.1016/j. amjcard.2017.05.020.
[25]
Yan F,Pan B,Sun H,et al. Risk factors of coronary artery abnormality in children with kawasaki disease:a systematic review and meta-analysis[J]. Front Pediatr,2019(7):374. DOI:10. 3389/fped.2019.00374.
[26]
杜忠东,赵地,杜军保,等.静脉注射丙种球蛋白应用时间对川崎病疗效的影响[J]. 中华医学杂志,2009,89(26):1841-1843.DOI:10.3760/cma.j.issn.0376-2491.2009.26.014.
[27]
Campbell AJ,Burns JC.Adjunctive therapies for Kawasaki disease[J]. J Infect,2016(72 Suppl):S1-S5. DOI:10. 1016/j. jinf.2016.04.015.
[28]
Shashaani N,Shiari R,Karimi A,et al. Determination of the relationship between kobayashi,sano,and egami criteria and prevalence of intravenous immunoglobulin resistance and coronary artery aneurysm in iranian children with kawasaki disease[J]. Open Access Rheumatol,2020(12):187-192. DOI:10. 2147/OARRR.S255138.
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