摘要： 目的 探讨静脉注射丙种球蛋白（IVIG）无反应型川崎病（KD）的危险因素，提高IVIG无反应型KD患儿的诊断效能。方法 回顾性分析2012年1月至2020年12月中国医科大学附属第一医院诊断并治疗的KD患儿临床资料，采用SPSS 20.0软件建立logistic回归模型寻找KD患儿发生IVIG无反应的独立危险因素，针对危险因素进行赋值，得出新的评分体系。结果 最终进入logistic回归预测模型的有IVIG治疗前的降钙素原（PCT）、红细胞沉降率（ESR）和尿白细胞（LEU）及IVIG治疗后的白细胞（WBC）、中性粒细胞（NE）和PCT。多因素logistic回归分析结果显示，IVIG治疗前的PCT和ESR及IVIG治疗后的WBC、NE和PCT是IVIG无反应型KD的独立危险因素（均P < 0.05）；建立新的评分体系，灵敏度为69.2%，特异度为69.4%，约登指数为0.386。结论 IVIG治疗后的实验室指标对IVIG无反应的预测效能更强。

静脉注射丙种球蛋白无反应型川崎病的危险因素分析及新评分体系建立

林小楠, 姜红堃

中国医科大学附属第一医院儿科, 沈阳 110001

收稿日期:2023-03-31出版日期:2023-09-30发布日期:2023-09-02
通讯作者:姜红堃E-mail:jianghongkun007@163.com
作者简介:林小楠(1994-),女,医师,硕士.
基金资助:辽宁省科技计划项目（2021JH2/1030008）


关键词: 川崎病, 丙种球蛋白无反应, 危险因素
Abstract: Objective To investigate the risk factors for intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD), and improve its diagnostic efficacy in children with KD. Methods A retrospective analysis was conducted on the clinical data of KD patients diagnosed and treated at the First Hospital of China Medical University between January 2012 and December 2020. A logistic regression model was established using SPSS 20.0 software to identify independent risk factors for IVIG resistance in KD patients. The risk factors were assigned values, and a new scoring system was developed. Results The results of the multivariate logistic regression analysis showed that procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) before IVIG treatment, as well as white blood cell count, neutrophil, and PCT after IVIG treatment, were independent risk factors for IVIG resistance in KD (both P < 0.05), establishing a new scoring system with a sensitivity of 69.2%, a specificity of 69.4%, and a Youden index of 0.386. Conclusion Laboratory parameters exhibit a strong predictive power for IVIG resistance in KD following IVIG treatment.
Key words: Kawasaki disease, intravenous immunoglobulin-resistance, risk factors
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