摘要
目的:探讨治疗前白蛋白(ALB)与血沉(ESR)比值、乳酸脱氢酶(LDH)联合全身免疫炎症指数(SII)对川崎病患儿静脉注射常规剂量免疫球蛋白(IVIG)应答不良的预测价值。方法:选取接受IVIG治疗的川崎病患儿189例,根据IVIG治疗应答分为敏感组和非敏感组,并按照7∶3比例收集川崎病患儿81例作为数据验证集。比较两组一般资料及治疗前ALB/ESR、LDH、SII水平,采用点二列相关性分析治疗前ALB/ESR、LDH、SII与IVIG治疗应答的相关性,采用受试者工作特征(ROC)曲线分析三项对川崎病患儿常规剂量IVIG应答不良的预测价值,采用Kappa检验分析三项联合预测的结果与数据验证集的一致性。结果:经治疗后评估,189例川崎病患儿中,非敏感组28例,敏感组161例。非敏感组最高体温及LDH、SII高于敏感组,ALB/ESR低于敏感组(均P<0.05)。治疗前ALB/ESR与IVIG治疗应答呈正相关(r=0.801,P<0.001),LDH、SII与IVIG治疗应答呈负相关(r=-0.834、-0.875,均P<0.001)。偏相关分析证实,治疗前ALB/ESR、LDH、SII仍与IVIG治疗应答显著相关(均P<0.05)。治疗前ALB/ESR、LDH、SII对IVIG治疗应答不良具有一定的预测价值,且三项联合的预测价值高于单项(均P<0.05)。三项联合预测的结果与数据验证集的一致性较高,Kappa值为0.790,一致性为95.06%(P<0.05)。结论:治疗前ALB/ESR、LDH、SII与川崎病患儿常规剂量IVIG治疗应答显著相关,对治疗应答不良具有一定的预测效能,三项联合检测能提高预测价值。
Objective:To explore the value of albumin(ALB)to erythrocyte sedimentation rate(ESR)ratio,lactate dehydrogenase(LDH)combined with Systemic Immune-Inflammation Index(SII)before treatment in predicting poor response to conventional dose intravenous immunoglobulin(IVIG)in children with Kawasaki disease.Methods:A total of 189 children with Kawasaki disease who received IVIG treatment were enrolled and divided into sensitive group and non-sensitive group according to the response to IVIG treatment.According to the ratio of 7∶3,81 children with Kawasaki disease were collected as the data validation set.The general data and the levels of ALB/ESR,LDH and SIIbefore treatment were compared between the two groups,and the correlation between ALB/ESR,LDH,SIIbefore treatment and the response to IVIG treatment was analyzed point-biserial correlation analysis.ROC curve was used to analyze the predictive value of three indexes for poor response to conventional dose of IVIG in children with Kawasaki disease.Kappa test was used to analyze the consistency between the results of the three joint predictions and the data validation set.Results:By evaluation after treatment,among 189 children with Kawasaki disease,28 were in the non-sensitive group and 161 were in the sensitive group.The maximum body temperature,LDH and SII in the non-sensitive group were higher than those in the sensitive group,and the ALB/ESR was lower than that in the sensitive group(all P<0.05).ALB/ESR before treatment was positively correlated with IVIG treatment response(r=0.801,P<0.001),LDH and SIIwere negatively correlated with IVIG treatment response(r=-0.834,-0.875,both P<0.001).Partial correlation analysis confirmed that ALB/ESR,LDH and SIIbefore treatment were still significantly correlated with IVIG treatment response(all P<0.05).ALB/ESR,LDH and SIIbefore treatment had certain predictive value for poor response to IVIG treatment,and the predictive value of the combination of the three was higher than that of each single item(all P<0.05).The results of the three joint predictions were highly consistent with the data validation set,with a Kappa value of 0.790 and a consistency of 95.06%(P<0.05).Conclusion:ALB/ESR,LDH and SIIbefore treatment are significantly correlated with the response to conventional dose IVIG treatment in children with Kawasaki disease,and they have certain predictive values for poor response to IVIG treatment,and the combined detection of the three indicators can improve the predictive value.
作者
黄小琼
陈相才
冯维
孙自国
HUANG Xiaoqiong;CHEN Xiangcai;FENG Wei;SUN Ziguo(Department of Pediatrics,Bazhong Hospital Affiliated to North Sichuan Medical College,Bazhong 636000,China)
出处
《陕西医学杂志》
2025年第9期1243-1247,共5页
Shaanxi Medical Journal
基金
四川省医学(青年创新)科研课题(S19227)。
