川崎病静脉注射免疫球蛋白无反应预测评分模型的建立

doi:10.7499/j.issn.1008-8830.2408077

Abstract
Figure/Table
References(28)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (618 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To explore the predictive factors for non-response to intravenous immunoglobulin (IVIG) in children with Kawasaki disease (KD) and to establish an IVIG non-response prediction scoring model for the Sichuan region. Methods A retrospective study was conducted by collecting clinical data from children with KD admitted to four tertiary hospitals in Sichuan Province between 2019 and 2023. Among them, 940 children responded to IVIG, while 74 children did not respond. Multivariate logistic regression analysis was used to identify the predictive factors for non-response to IVIG and to establish a predictive scoring model. The model's effectiveness was assessed using the receiver operating characteristic curve (ROC) and validated with an independent dataset. Results Multivariate logistic regression analysis showed that the platelet-to-lymphocyte ratio (PLR), hemoglobin (Hb), serum creatinine, aspartate aminotransferase (AST), and platelet count (PLT) were closely related to non-response to IVIG in children with KD (P<0.05). Based on these indicators, a predictive scoring model was established: PLR > 199, 0.4 points; Hb ≤ 116 g/L, 4 points; AST > 58 U/L, 0.2 points; serum creatinine > 38 μmol/L, 3.9 points; PLT count ≤ 275 × 109/L, 0.3 points. Using this model, children with KD were scored, and a total score greater than 4.3 was considered high risk of non-response to IVIG. The sensitivity of the model in predicting non-response to IVIG was 77.0%, specificity was 65.7%, and the area under the ROC curve was 0.746 (95%CI: 0.688-0.805). Conclusions The predictive scoring model based on PLR, Hb, serum creatinine, AST, and PLT demonstrates good predictive performance for non-response to IVIG in children with KD in the Sichuan region and can serve as a reference for clinical decision-making.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	HUANG Yi-Xu
	HUANG Yu
	PI Guang-Huan

Key words： Kawasaki disease Non-response to intravenous immunoglobulin Predictive scoring model Child

Received: 15 August 2024

Corresponding Authors: Pi G-H,piguanghuan@126.com。 E-mail: piguanghuan@126.com

Cite this article:

HUANG Yi-Xu,HUANG Yu,PI Guang-Huan. Development of a predictive scoring model for non-response to intravenous immunoglobulin in Kawasaki disease[J]. CJCP, 2025, 27(1): 75-81.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2408077 OR http://www.zgddek.com/EN/Y2025/V27/I1/75

	陕西省川崎病诊疗中心, 陕西省儿童内科疾病临床医学研究中心, 陕西省人民医院儿童病院, 等. 静脉输注免疫球蛋白在儿童川崎病中应用的专家共识[J]. 中国当代儿科杂志, 2021, 23(9): 867-876. PMID: 34535199. PMCID: PMC8480171. DOI: 10.7499/j.issn.1008-8830.2107110.
	de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease: the SHARE initiative[J]. Rheumatology (Oxford), 2019, 58(4): 672-682. PMID: 30535127. DOI: 10.1093/rheumatology/key344.
	陕西省川崎病诊疗中心/陕西省人民医院儿童病院, 国家儿童医学中心/首都医科大学附属北京儿童医院, 上海交通大学医学院附属儿童医院, 等. 中国儿童川崎病诊疗循证指南（2023年）[J]. 中国当代儿科杂志, 2023, 25(12): 1198-1210. PMID: 38112136. PMCID: PMC10731970. DOI: 10.7499/j.issn.1008-8830.2309038.
	Rife E, Gedalia A. Kawasaki disease: an update[J]. Curr Rheumatol Rep, 2020, 22(10): 75. PMID: 32924089. PMCID: PMC7487199. DOI: 10.1007/s11926-020-00941-4.
	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. PMID: 34986616. DOI: 10.3760/cma.j.cn112140-20211018-00879.
	黄国英. 川崎病诊断和治疗面临的挑战[J]. 中华儿科杂志, 2022, 60(1): 3-5. PMID: 34986615. DOI: 10.3760/cma.j.cn112140-20211104-00927.
	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. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
	Riley RD, Ensor J, Snell KIE, et al. Calculating the sample size required for developing a clinical prediction model[J]. BMJ, 2020, 368: m441. PMID: 32188600. DOI: 10.1136/bmj.m441.
	Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease[J]. J Pediatr, 2006, 149(2): 237-240. PMID: 16887442. DOI: 10.1016/j.jpeds.2006.03.050.
	Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease[J]. Circulation, 2006, 113(22): 2606-2612. PMID: 16735679. DOI: 10.1161/CIRCULATIONAHA.105.592865.
	Fu PP, Du ZD, Pan YS. Novel predictors of intravenous immunoglobulin resistance in Chinese children with Kawasaki disease[J]. Pediatr Infect Dis J, 2013, 32(8): e319-e323. PMID: 23446442. DOI: 10.1097/INF.0b013e31828e887f.
	12 王丽平. 免疫球蛋白无反应型川崎病危险因素的研究及评分体系探讨[D]. 上海: 上海交通大学, 2014.
	Lin MT, Chang CH, Sun LC, et al. Risk factors and derived Formosa score for intravenous immunoglobulin unresponsiveness in Taiwanese children with Kawasaki disease[J]. J Formos Med Assoc, 2016, 115(5): 350-355. PMID: 25910931. DOI: 10.1016/j.jfma.2015.03.012.
	Yang S, Song R, Zhang J, et al. Predictive tool for intravenous immunoglobulin resistance of Kawasaki disease in Beijing[J]. Arch Dis Child, 2019, 104(3): 262-267. PMID: 30026252. DOI: 10.1136/archdischild-2017-314512.
	Wu S, Liao Y, Sun Y, et al. Prediction of intravenous immunoglobulin resistance in Kawasaki disease in children[J]. World J Pediatr, 2020, 16(6): 607-613. PMID: 32232677. DOI: 10.1007/s12519-020-00348-2.
	16 江彦秋, 黄先玫. 川崎病的免疫与遗传学发病机制研究进展[J]. 中华实用儿科临床杂志, 2017, 32(9): 717-720. DOI: 10.3760/cma.j.issn.2095-428X.2017.09.021.
	Xu B, Zhang Q, Du J, et al. Prediction of intravenous immunoglobulin-resistant Kawasaki disease: a research hotspot[J]. Sci Bull (Beijing), 2023, 68(2): 121-124. PMID: 36681588. DOI: 10.1016/j.scib.2023.01.019.
	18 胡昌灿, 于海初, 孙桂霞, 等. 血小板/淋巴细胞比值联合Grace评分对非ST段抬高型急性冠状动脉综合征院内心血管事件的预测价值[J]. 中国动脉硬化杂志, 2019, 27(8): 700-707. DOI: 10.3969/j.issn.1007-3949.2019.08.011.
	19 张书婉, 黄君华, 吴文婧, 等. 外周血NLR与PLR对儿童完全型川崎病冠状动脉损伤的预测分析[J]. 现代检验医学杂志, 2020, 35(6): 38-41. DOI: 10.3969/j.issn.1671-7414.2020.06.010.
	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. PMID: 28407827. PMCID: PMC7389660. DOI: 10.7499/j.issn.1008-8830.2017.04.010.
	李燕羽, 袁晨辰, 蔡艾媛, 等. 血小板与淋巴细胞比值对中国川崎病患儿冠状动脉病变预测价值的Meta分析[J]. 中国当代儿科杂志, 2023, 25(12): 1219-1226. PMID: 38112138. PMCID: PMC10731965. DOI: 10.7499/j.issn.1008-8830.2306097.
	Kanai T, Takeshita S, Kawamura Y, et al. The combination of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as a novel predictor of intravenous immunoglobulin resistance in patients with Kawasaki disease: a multicenter study[J]. Heart Vessels, 2020, 35(10): 1463-1472. PMID: 32449049. DOI: 10.1007/s00380-020-01622-z.
	Grignani R, Rajgor DD, Leow YG, et al. A novel model for predicting non-responsiveness to intravenous immunoglobulins in Kawasaki disease: the Singapore experience[J]. J Paediatr Child Health, 2019, 55(8): 962-967. PMID: 30520192. DOI: 10.1111/jpc.14329.
	24 彭珍, 闫孝永. ACEF评分联合炎性因子评估小儿川崎病冠状动脉损害的临床价值[J]. 中西医结合心脑血管病杂志, 2022, 20(16): 3016-3020. DOI: 10.12102/j.issn.1672-1349.2022.16.029.
	Sano T, Kurotobi S, Matsuzaki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment[J]. Eur J Pediatr, 2007, 166(2): 131-137. PMID: 16896641. DOI: 10.1007/s00431-006-0223-z.
	Moon KP, Kim BJ, Lee KJ, et al. Prediction of nonresponsiveness to medium-dose intravenous immunoglobulin (1 g/kg) treatment: an effective and safe schedule of acute treatment for Kawasaki disease[J]. Korean J Pediatr, 2016, 59(4): 178-182. PMID: 27186228. PMCID: PMC4865641. DOI: 10.3345/kjp.2016.59.4.178.
	胡慧敏, 陈笑征, 张永兰, 等. 川崎病急性期肝损害与冠状动脉损伤和免疫球蛋白无反应的关系[J]. 中国当代儿科杂志, 2022, 24(6): 681-686. PMID: 35762436. PMCID: PMC9250406. DOI: 10.7499/j.issn.1008-8830.2112094.
	Liu G, Wang S, Du Z. Risk factors of intravenous immunoglobulin resistance in children with Kawasaki disease: a meta-analysis of case-control studies[J]. Front Pediatr, 2020, 8: 187. PMID: 32373568. PMCID: PMC7186309. DOI: 10.3389/fped.2020.00187.