Ha Kee-Soo, Lee Jeehoo, Jang Gi Young, Lee JungHwa, Lee Kwang Chul, Son Chang Sung, Lee Joo Won
Department of Pediatrics, Korea University Medical Center, Guro Hospital, Seoul, Korea.
Department of Pediatrics, Korea University Medical Center, Ansan Hospital, Seoul, Korea.
Am J Cardiol. 2015 Jul 15;116(2):301-6. doi: 10.1016/j.amjcard.2015.04.021. Epub 2015 Apr 18.
Total and differential leukocyte counts are useful inflammatory biomarkers. The ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with Kawasaki disease (KD) was assessed in this study. All patients with KD who underwent consecutive complete blood count analyses during the acute febrile phase before intravenous immunoglobulin (IVIG), 2 days after IVIG regardless of defervescence, and 3 to 4 weeks after defervescence were enrolled. NLR was calculated by dividing the neutrophil count by the lymphocyte count. NLR values that best predicted IVIG resistance and the development of coronary artery abnormalities were determined by receiver-operating characteristic curve and multivariate analyses. Of the 587 patients with KD, 222 were IVIG resistant. IVIG-resistant patients had higher NLRs than IVIG-responsive patients. The best NLR cut-off values during the acute febrile phase and 2 days after IVIG for predicting IVIG resistance were 5.49 (p <0.001) and 1.26 (p <0.001), respectively. Sixty-two patients developed coronary artery abnormalities; 47 had coronary dilatation, and 15 had aneurysms. Patients with aneurysms, but not patients with dilatation, had higher NLRs than patients without coronary artery abnormalities. The best NLR cut-off value 2 days after IVIG for predicting aneurysm development was 1.01 (p <0.001). Multivariate analysis revealed that the NLR 2 days after IVIG independently predicted coronary aneurysm development (p = 0.03) and IVIG resistance (p <0.001). In conclusion, the NLR can be used for risk stratification in patients with KD. An NLR 2 days after IVIG that exceeded 1 was predictive of coronary aneurysm development and IVIG resistance.
白细胞总数及分类计数是有用的炎症生物标志物。本研究评估了中性粒细胞与淋巴细胞比值（NLR）预测川崎病（KD）患者预后的能力。纳入了所有在静脉注射免疫球蛋白（IVIG）前急性发热期、IVIG注射后2天（无论是否退热）以及退热后3至4周接受连续全血细胞计数分析的KD患者。NLR通过中性粒细胞计数除以淋巴细胞计数来计算。通过受试者操作特征曲线和多变量分析确定最能预测IVIG抵抗和冠状动脉异常发生的NLR值。在587例KD患者中，222例对IVIG抵抗。IVIG抵抗患者的NLR高于IVIG反应性患者。急性发热期和IVIG注射后2天预测IVIG抵抗的最佳NLR临界值分别为5.49（p<0.001）和1.26（p<0.001）。62例患者出现冠状动脉异常；47例有冠状动脉扩张，15例有动脉瘤。有动脉瘤的患者，而非有扩张的患者，其NLR高于无冠状动脉异常的患者。IVIG注射后2天预测动脉瘤发生的最佳NLR临界值为1.01（p<0.001）。多变量分析显示，IVIG注射后2天的NLR可独立预测冠状动脉瘤的发生（p = 0.03）和IVIG抵抗（p<0.001）。总之，NLR可用于KD患者的风险分层。IVIG注射后2天NLR超过1可预测冠状动脉瘤的发生和IVIG抵抗。
