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

Values of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in predicting sensitivity to intravenous immunoglobulin in Kawasaki disease

摘要:

目的 分析中性粒细胞与淋巴细胞比值（NLR）及血小板与淋巴细胞比值（PLR）对川崎病（KD）免疫球蛋白（IVIG）敏感性的预测作用。方法 采用回顾性队列研究，以404例初诊川崎病患者为研究对象，收集IVIG治疗前后的血常规、NLR和PLR值，通过ROC曲线确定NLR和PLR在预测川崎病IVIG不敏感的最佳cut-off值；用logistic回归确定IVIG不敏感的独立预测因素。结果 404例川崎病患者中31例IVIG不敏感。与IVIG敏感组相比，IVIG不敏感组的冠状动脉扩张发生率明显增高（P < 0.01）；启用IVIG时的病程较短（P < 0.05）；IVIG治疗前后的NLR、PLR水平以及CRP均较高（P < 0.05）。IVIG治疗前、后的NLR和PLR对川崎病IVIG不敏感最佳预测值分别为4.36、162和1.45、196。多元回归分析显示IVIG治疗前的病程、CRP，以及IVIG治疗前后的NLR和PLR是IVIG不敏感的独立预测因素。结论 NLR和PLR可能作为川崎病患者丙球不敏感的预测指标。

Abstract:

Objective To study the values of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting the sensitivity to intravenous immunoglobulin (IVIG) in Kawasaki disease (KD). Methods A retrospective cohort study was conducted in 404 children with newly diagnosed KD. The data on routine blood tests, NLR, and PLR were collected before and after IVIG treatment. The receiver operating characteristic (ROC) curve was used to determine the cut-off values of NLR and PLR in predicting the insensitivity to IVIG. A logistic regression analysis was used to identify independent predictive factors for insensitivity to IVIG. Results Of all patients, 31 were insensitive to IVIG. Compared with the IVIG sensitivity group, the IVIG insensitivity group had a significantly higher incidence rate of coronary artery ectasia (P < 0.01), a shorter course of disease when IVIG therapy was initiated (P < 0.05), and significantly higher NLR, PLR, and C-reactive protein (CRP) level before and after treatment (P < 0.05). The optimal cut-off values for NLR and PLR to predict IVIG insensitivity were 4.36 and 162 before IVIG treatment and 1.45 and 196 after treatment. The multivariate regression analysis showed that the course of disease before IVIG treatment, CRP before IVIG treatment, and NLR and PLR before and after IVIG treatment were independent predictive factors for IVIG insensitivity. Conclusions NLR and PLR can be used to predict IVIG insensitivity in children with KD.