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

doi:10.3877/cma.j.issn.2095-655X.2025.01.008

Abstract

Abstract:

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

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]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(01): 51-58.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhzdxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-655X.2025.01.008

https://zhzdxdzzz.cma-cmc.com.cn/EN/Y2025/V13/I01/51

Figures/Tables 7

References 28

[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.

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

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

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

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

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)

Please choose a citation manager

Content to export