外周血淋巴细胞亚群对静脉注射免疫球蛋白无反应型川崎病患儿的预测价值

Predictive value of peripheral blood lymphocyte subsets for children with intravenous immunoglobulin-resistant Kawasaki disease

摘要:

目的 基于外周血淋巴细胞亚群及常见实验室检查指标，构建静脉注射免疫球蛋白（intravenous immunoglobulin, IVIG）无反应型川崎病（Kawasaki disease, KD）预测评分体系。方法 纳入2021年1月—2023年3月于天津市儿童医院住院的KD患儿为研究对象（IVIG敏感型185例，IVIG无反应型41例）。选取年龄、性别匹配的健康儿童46例为对照。采用流式细胞仪检测外周血淋巴细胞亚群比例和绝对计数。采用多因素logistic回归分析探讨IVIG无反应型KD的预测因素，并构建IVIG无反应型KD预测评分体系。结果 多因素logistic回归分析显示，CD4⁺T细胞绝对计数、自然杀伤细胞绝对计数、血清钠水平、球蛋白水平及总胆红素水平是IVIG无反应型KD的预测因素（P<0.05）。基于这些预测因素建立的IVIG无反应型KD的预测评分体系的灵敏度为70.7%，特异度为83.8%。结论 外周血淋巴细胞亚群可作为儿童IVIG无反应型KD的预测指标；引入该指标建立的评分体系对预测儿童IVIG无反应型KD有较高的准确度。

Abstract:

Objective Based on peripheral blood lymphocyte subsets and common laboratory test indexes, this study aimed to construct a predictive scoring system for intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD).Methods Children hospitalized in Tianjin Children's Hospital from January 2021 to March 2023 were included in the study (185 cases of IVIG-sensitive KD and 41 cases of IVIG -resistant KD). Forty-six healthy children matched for age and gender were selected as controls. The relative percentage and absolute counts of peripheral lymphocyte subsets were measured by flow cytometry. Multivariate logistic regression was used to identify the predictive factors for IVIG-resistant KD and to construct a predictive scoring system for predicting IVIG-resistant KD.Results The multivariate logistic regression analysis showed that CD4⁺ T cell absolute count, natural killer cell absolute count, serum sodium level, globulin level, and total bilirubin level were identified as predictive factors for IVIG-resistant KD (P<0.05). The predictive scoring system based on these factors achieved a sensitivity of 70.7% and a specificity of 83.8% in predicting IVIG-resistant KD.Conclusions Peripheral blood lymphocyte subsets can serve as predictive indicators for IVIG-resistant KD in children. The introduction of this indicator and the establishment of a scoring system based on it can provide a higher accuracy in predicting IVIG-resistant KD in children.