Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China.
World J Pediatr. 2019 Apr;15(2):168-175. doi: 10.1007/s12519-019-00234-6. Epub 2019 Feb 27.
Currently, there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease.
A total of 300 patients with Kawasaki disease were studied retrospectively. Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups, and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions.
The intravenous immunoglobulin resistant group had significantly higher D-dimer, globulin, interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group. D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L. Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L. Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL. The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level. D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L. Based on analysis by multivariate logistic regression, serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance, D-dimer was independent risk for coronary artery lesions.
Elevated serum ferritin, globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease. Moreover, serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.
目前，尚无可靠指标来预测川崎病早期静脉注射免疫球蛋白（IVIG）抵抗和冠状动脉病变。
回顾性研究了 300 例川崎病患者。比较 IVIG 抵抗（29 例）和 IVIG 反应组、有冠状动脉病变（48 例）和无冠状动脉病变组的实验室数据。
IVIG 抵抗组的 D-二聚体、球蛋白、白细胞介素-6 和血清铁蛋白水平明显高于 IVIG 反应组。D-二聚体水平在截断值为 1.09mg/L 时预测 IVIG 抵抗的敏感性为 87.0%，特异性为 56.3%。球蛋白在截断值为 34.7g/L 时预测 IVIG 抵抗的敏感性为 62.1%，特异性为 82.3%。血清铁蛋白水平在截断值为 269.7ng/mL 时预测 IVIG 抵抗的敏感性为 42.9%，特异性为 88.8%。有冠状动脉病变的患者 D-二聚体和肿瘤坏死因子-α水平较高。D-二聚体水平在截断值为 1.84mg/L 时预测冠状动脉病变的敏感性为 50%，特异性为 78.6%。多因素 logistic 回归分析显示，血清铁蛋白和球蛋白是 IVIG 抵抗的独立危险因素，D-二聚体是冠状动脉病变的独立危险因素。
血清铁蛋白、球蛋白和 D-二聚体水平升高与川崎病 IVIG 抵抗显著相关。此外，川崎病合并冠状动脉病变时血清 D-二聚体明显升高。
