急性时相反应蛋白SAA和CRP对川崎病静脉注射免疫球蛋白无应答的预测价值

doi:10.11958/20221011

摘要/Abstract

摘要： Objective To evaluate the predictive value of acute phase proteins serum amyloid A protein (SAA) and C-reactive protein (CRP) for non-response to intravenous immunoglobulin (IVIG) in children with Kawasaki disease (KD). Methods According to the IVIG resistant definition, a total of 358 KD patients were assigned into the IVIG resistant group (n=41) and the IVIG responsive group (n=317). Serum levels of SAA and CRP were tested, and SAA/CRP ratio was calculated. Clinical and laboratory data before and after treatment were compared between the two groups. Binary Logistic regression analysis was used to identify influencing factors for resistance to IVIG. The diagnostic value of SAA and CRP in predicting IVIG resistance in KD was investigated by the receiver operating characteristic (ROC) curve. Results The levels of CRP, SAA, total bilirubin, alanine aminotransferase and asparate aminotransferase were significantly higher in the IVIG resistant group than those of the IVIG responsive group (P<0.05), whereas levels of lymphocyte count, platelet count, serum sodium and duration of fever before IVIG were significantly lower in the IVIG resistant group (P<0.05). The binary Logistic regression analysis showed that CRP (OR=1.008, 95%CI: 1.001-1.015), SAA (OR=1.002, 95%CI: 1.001-1.003), total bilirubin (OR=1.030, 95%CI: 1.009-1.051), serum sodium (OR=0.862, 95%CI: 0.762-0.975), lymphocyte count (OR=0.733, 95%CI: 0.567-0.947) and duration of fever before IVIG (OR=0.688, 95%CI: 0.513-0.922) were the independent influencing factors for IVIG resistance (P<0.05). The incidence of coronary artery lesion was significantly higher after therapy in the IVIG resistant group than that in the IVIG responsive group (P<0.05). ROC curve showed that the Youden index of SAA (cut-off value 252.45 mg/L), CRP (cut-off value 82.80 mg/L) and combined SAA and CRP were 0.325, 0.382 and 0.423. The area under the ROC curve of SAA, CRP and two items were 0.681, 0.703 and 0.761, respectively. The predictive efficiency of combined application was larger. Conclusion The increased SAA and CRP levels are independent risk factors of IVIG resistance, which can be utilized as combined biomarkers for the prediction of IVIG resistance in KD patients.

关键词: 黏膜皮肤淋巴结综合征, 免疫球蛋白类, 血清淀粉样蛋白A, C反应蛋白质, ROC曲线, 危险因素

Key words: mucocutaneous lymph node syndrome, immunoglobulins, serum amyloid a protein, C-reactive protein, ROC curve, risk factors

中图分类号:

R725.41

图/表 4

参考文献 16

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组别	n	年龄（月）	性别（男/女）	体质量（kg）	IVIG前发热时间（d）	不完全性KD	WBC（×10⁹/L）
IVIG应答组	317	23（12，36）	199/118	12.3（10.0，15.0）	6（5，7）	23（7.3）	14.27（11.18，17.81）
IVIG无应答组	41	24（10，36）	28/13	12.0（9.5，14.5）	5（5，6）	5（12.2）	15.49（12.58，19.08）
Z或χ²		0.345	0.476	0.872	2.906^＊＊	0.639	1.797

组别	n	年龄（月）	性别（男/女）	体质量（kg）	IVIG前发热时间（d）	不完全性KD	WBC（×10⁹/L）
IVIG应答组	317	23（12，36）	199/118	12.3（10.0，15.0）	6（5，7）	23（7.3）	14.27（11.18，17.81）
IVIG无应答组	41	24（10，36）	28/13	12.0（9.5，14.5）	5（5，6）	5（12.2）	15.49（12.58，19.08）
Z或χ²		0.345	0.476	0.872	2.906^＊＊	0.639	1.797

变量	β	SE	Wald χ²	P	OR（95%CI）
CRP	0.008	0.003	5.502	0.019	1.008（1.001~1.015）
SAA	0.002	0.001	8.467	0.004	1.002（1.001~1.003）
TBIL	0.029	0.011	7.657	0.006	1.030（1.009~1.051）
血清钠	-0.149	0.063	5.555	0.018	0.862（0.762~0.975）
LYM	-0.311	0.131	5.639	0.018	0.733（0.567~0.947）
IVIG前发热时间	-0.374	0.150	6.249	0.012	0.688（0.513~0.922）
常数项	19.393	8.530	5.169	0.023	2.644×10⁸

变量	β	SE	Wald χ²	P	OR（95%CI）
CRP	0.008	0.003	5.502	0.019	1.008（1.001~1.015）
SAA	0.002	0.001	8.467	0.004	1.002（1.001~1.003）
TBIL	0.029	0.011	7.657	0.006	1.030（1.009~1.051）
血清钠	-0.149	0.063	5.555	0.018	0.862（0.762~0.975）
LYM	-0.311	0.131	5.639	0.018	0.733（0.567~0.947）
IVIG前发热时间	-0.374	0.150	6.249	0.012	0.688（0.513~0.922）
常数项	19.393	8.530	5.169	0.023	2.644×10⁸

指标	敏感度（%）	特异度（%）	截断值	AUC（95%CI）	约登指数
SAA	73.2	59.3	252.45 mg/L	0.681（0.597~0.764）	0.325
CRP	73.2	65.0	82.80 mg/L	0.703（0.626~0.779）	0.382
SAA+CRP	73.2	69.1	-	0.761（0.690~0.832）	0.423