血清脂质对川崎病静脉免疫球蛋白抵抗和冠状动脉病变的预测价值。
Predictive Value of Serum Lipid for Intravenous Immunoglobulin Resistance and Coronary Artery Lesion in Kawasaki Disease.
机构信息
Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
West China Medical School of Sichuan University, Chengdu, Sichuan, China.
出版信息
J Clin Endocrinol Metab. 2021 Sep 27;106(10):e4210-e4220. doi: 10.1210/clinem/dgab230.
CONTEXT
Intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) prediction are pivotal topic of interests in Kawasaki disease (KD). However, data on the predictive value of lipid profile for both IVIG resistance and CALs are limited.
PURPOSE
To investigate the predictive validity of lipid profile for IVIG resistance and CALs in KD.
DESIGN
Prospective cohort study.
SETTING
West China Second University Hospital.
PATIENTS
363 KD patients were divided into the initial IVIG-resistant group and initial IVIG-responsive group; repeated IVIG-resistant group and repeated IVIG-responsive group; CAL+ group and CAL- group.
MAIN OUTCOME MEASURES
Validity of lipid profile in predicting IVIG resistance and CALs.
RESULTS
Triglycerides were significantly higher whereas total cholesterol (TC), high-densisty lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein A (Apo A) were significantly lower in initial IVIG-resistant subjects, with cut-off values of 1.625 mmol/L, 3.255 mmol/L, 0.475 mmol/L, 1.965 mmol/L, and 0.665 g/L, yielding sensitivities of 52%, 70%, 52%, 61%, and 50% and specificities of 68%, 53%, 78%, 71%, and 81%, respectively. TC, LDL-C, and Apo A levels were significantly lower in repeated IVIG-resistant subjects, with cut-off values of 3.20 mmol/L, 1.78 mmol/L, and 0.605 g/L, producing sensitivities of 91%, 70%, and 57% and specificities of 55%, 67%, and 70%, respectively. Apo A level was significantly lower in the CAL+ group, with cut-off value of 0.805 g/L, yielding sensitivity of 66% and specificity of 54%.
CONCLUSIONS
Lipid profiles were significantly dysregulated in KD patients suffering IVIG resistance and CALs. Some of them, such as LDL-C and Apo A, could serve as complementary laboratory markers for predicting both IVIG resistance and CALs.
背景
静脉注射免疫球蛋白（IVIG）耐药和冠状动脉病变（CALs）预测是川崎病（KD）的研究热点。然而，血脂谱对 IVIG 耐药和 CALs 的预测价值的数据有限。
目的
探讨血脂谱对 KD 患者 IVIG 耐药和 CALs 的预测价值。
设计
前瞻性队列研究。
地点
四川大学华西第二医院。
患者
363 例 KD 患者分为初始 IVIG 耐药组和初始 IVIG 敏感组、重复 IVIG 耐药组和重复 IVIG 敏感组、CAL+组和 CAL-组。
主要观察指标
血脂谱预测 IVIG 耐药和 CALs 的有效性。
结果
初始 IVIG 耐药组患者的甘油三酯显著升高，而总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和载脂蛋白 A（Apo A）显著降低，截断值分别为 1.625 mmol/L、3.255 mmol/L、0.475 mmol/L、1.965 mmol/L 和 0.665 g/L，敏感性分别为 52%、70%、52%、61%和 50%，特异性分别为 68%、53%、78%、71%和 81%。重复 IVIG 耐药组患者的 TC、LDL-C 和 Apo A 水平显著降低，截断值分别为 3.20 mmol/L、1.78 mmol/L 和 0.605 g/L，敏感性分别为 91%、70%和 57%，特异性分别为 55%、67%和 70%。CAL+组患者的 Apo A 水平显著降低，截断值为 0.805 g/L，敏感性为 66%，特异性为 54%。
结论
KD 患者发生 IVIG 耐药和 CALs 时，血脂谱显著失调。其中一些指标，如 LDL-C 和 Apo A，可作为预测 IVIG 耐药和 CALs 的补充实验室标志物。
Zotero 插件