5岁以上川崎病儿童合并冠状动脉病变的预测指标与风险模型构建

doi:10.7499/j.issn.1008-8830.2309103

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摘要目的探讨5岁以上川崎病（Kawasaki disease, KD）儿童合并冠状动脉病变（coronary artery lesion）的预测指标并构建风险预测模型。方法回顾性分析2018年1月—2023年1月华中科技大学同济医学院附属武汉儿童医院收治的5岁以上KD患儿的临床资料，其中合并CAL 47例，未合并CAL 178例。采用多因素logistic回归分析探讨5岁以上KD儿童合并CAL发生的预测指标并构建风险预测模型，采用受试者操作特性曲线评价预测模型的效果。最后根据Framingham风险评分法对预测指标进行分层量化，计算各指标对5岁以上KD儿童合并CAL预测的贡献值并构建风险预测评分模型。结果多因素logistic回归分析显示，首剂静脉注射免疫球蛋白（intravenous immunoglobulin, IVIG）治疗前发热时长（OR=1.374，95%CI：1.117~1.689）、超敏C反应蛋白（hypersensitive C-reactive protein, hs-CRP；OR=1.008，95%CI：1.001~1.015）及血清铁蛋白（OR=1.002，95%CI：1.001~1.003）是5岁以上KD儿童合并CAL发生的预测指标。各指标预测CAL发生的最佳截断值为：首剂IVIG治疗前发热时长为6.5 d（AUC=0.654，95%CI：0.565~0.744），hs-CRP为110.50 mg/L（AUC=0.686，95%CI：0.597~0.774），铁蛋白为313.62 mg/L（AUC=0.724，95%CI：0.642~0.805）。据Framingham风险评分法对预测指标赋值并构建风险预测评分模型，将CAL发生的低、中、高危状态分别定义为发生概率<10%、10%~20%和>20%，对应分值分别为0~4分、5~6分、≥7分。结论在5岁以上KD患儿中，首次IVIG治疗前发热时间较长、hs-CRP水平较高或血清铁蛋白水平较高者，易发生CAL。

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	张华勇
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关键词 ：川崎病, 冠状动脉病变, 预测指标, 风险预测模型, 儿童

Abstract：Objective To study predictive indicators for coronary artery lesions (CAL) and construct a risk prediction model for CAL in Kawasaki disease (KD) children over 5 years old. Methods A retrospective analysis of KD children over 5 years old at Wuhan Children's Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to January 2023 was conducted. Among them, 47 cases were complicated with CAL, and 178 cases were not. Multivariate logistic regression analysis was used to explore predictive indicators for CAL in KD children over 5 years old and construct a risk prediction model. The receiver operating characteristic curve was used to evaluate the effectiveness of the prediction model. Finally, the Framingham risk scoring method was used to quantify the predictive indicators, calculate the contribution of each indicator to the prediction of CAL in KD children over 5 years old, and construct a risk prediction scoring model. Results The multivariate logistic regression analysis showed that the duration of fever before the initial intravenous immunoglobulin (IVIG) treatment (OR=1.374, 95%CI: 1.117-1.689), levels of hypersensitive C-reactive protein (hs-CRP; OR=1.008, 95%CI: 1.001-1.015), and serum ferritin levels (OR=1.002, 95%CI: 1.001-1.003) were predictive indicators for CAL in KD children over 5 years old. The optimal cutoff values for predicting CAL were: duration of fever before initial IVIG treatment of 6.5 days (AUC=0.654, 95%CI: 0.565-0.744), hs-CRP of 110.50 mg/L (AUC=0.686, 95%CI: 0.597-0.774), and ferritin of 313.62 mg/L (AUC=0.724, 95%CI: 0.642-0.805). According to the Framingham risk scoring method, the low, medium, and high-risk states of CAL occurrence were defined as probabilities of <10%, 10%-20%, and >20%, respectively, with corresponding scores of 0-4 points, 5-6 points, and ≥7 points. Conclusions In KD children over 5 years old, those with a longer duration of fever before initial IVIG treatment, higher levels of hs-CRP, or elevated serum ferritin levels are more likely to develop CAL.

Key words： Kawasaki disease Coronary artery lesion Predictive indicator Risk prediction model Child

收稿日期: 2023-09-18

基金资助:武汉儿童医院临床医学研究项目（2022FE011）。

通讯作者: 张勇，男，主任医师。Email：854804076@qq.com。 E-mail: 854804076@qq.com

作者简介: 张华勇，男，硕士，主治医师；

引用本文:

张华勇,张勇. 5岁以上川崎病儿童合并冠状动脉病变的预测指标与风险模型构建[J]. 中国当代儿科杂志, 2024, 26(5): 461-468.

ZHANG Huayong,ZHANG Yong. Predictive indicators and risk model construction for coronary artery lesions in Kawasaki disease children over 5 years old[J]. CJCP, 2024, 26(5): 461-468.

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