Kanai Takashi, Takeshita Seiichiro, Kawamura Yoichi, Kinoshita Keiji, Nakatani Keigo, Iwashima Satoru, Takizawa Yuji, Hirono Keiichi, Mori Kazuetsu, Yoshida Yusuke, Nonoyama Shigeaki
Department of Pediatrics, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan.
Division of Nursing, School of Medicine, National Defense Medical College, Tokorozawa, Japan.
Heart Vessels. 2020 Oct;35(10):1463-1472. doi: 10.1007/s00380-020-01622-z. Epub 2020 May 24.
The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to be a predictor for intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) recently. The objective of the present study was to elucidate the predictive validity of this new marker in a multicenter study.
We retrospectively reviewed the clinical records of 520 consecutive KD patients (development data set) and 332 subsequent patients (validation data set) at 7 hospitals in Japan.
Both NLR and PLR were significantly higher in the IVIG-resistant group than in the IVIG-responsive group. When we set the cut-off point as NLR ≥ 4.11 and PLR ≥ 119, multiple logistic regression analyses showed that a high NLR and PLR before initial IVIG were independent predictors of IVIG resistance, and their combination was a stronger predictor than either alone. The sensitivity and specificity of the combination of NLR ≥ 4.11 and PLR ≥ 119 were 0.58 and 0.73 in the development data set. Validated using an independent data set, they were 0.54 and 0.72 in the validation data set. On comparing the AUC of this predictor with those of the Gunma and Kurume scores, the AUC was highest for this predictor, followed by the Gunma score and Kurume score (0.70, 0.68, and 0.64, respectively).
The predictive validity of the combination of a high NLR and PLR, which is a simple and convenient indicator, was equal to or better than that of the existing scoring systems. The new predictive marker may be a suitable indicator for predicting IVIG resistance in KD patients.
最近有报道称，中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）可作为川崎病（KD）患者静脉注射免疫球蛋白（IVIG）抵抗的预测指标。本研究的目的是在一项多中心研究中阐明这一新指标的预测有效性。
我们回顾性分析了日本7家医院连续收治的520例KD患者（发展数据集）和332例后续患者（验证数据集）的临床记录。
IVIG抵抗组的NLR和PLR均显著高于IVIG反应组。当我们将截断点设定为NLR≥4.11和PLR≥119时，多因素logistic回归分析显示，初始IVIG治疗前的高NLR和PLR是IVIG抵抗的独立预测因素，二者联合预测比单独使用任一指标更强。在发展数据集中，NLR≥4.11和PLR≥119联合的敏感性和特异性分别为0.58和0.73。在独立数据集中进行验证时，验证数据集中二者的敏感性和特异性分别为0.54和0.72。将该预测指标的AUC与群马和久留米评分的AUC进行比较，该预测指标的AUC最高，其次是群马评分和久留米评分（分别为0.70、0.68和0.64）。
高NLR和PLR联合这一简单便捷的指标的预测有效性等于或优于现有的评分系统。新的预测指标可能是预测KD患者IVIG抵抗的合适指标。
