Tang Yunjia, Gang Miao, Qian Weiguo, Ma Jin, Xu Qiuqin, Lv Haitao
Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China.
Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, China.
Front Pediatr. 2021 Jun 4;9:652346. doi: 10.3389/fped.2021.652346. eCollection 2021.
To investigate the outcomes of coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in patients with and without neutropenia during the disease course and to explore the relationships between Δ absolute neutrophils count (ΔANC) and the outcomes. We retrospectively reviewed the medical records of patients hospitalized in Children's Hospital of Soochow University with a main diagnosis of KD during January 2019 and December 2019. 1:4 propensity score matching was carried out to adjust the baseline characteristics. Smoothed plots and threshold effect analyses were performed to reveal the relationships between ΔANC and the outcomes. Of the 438 patients enrolled, 75 (17.1%) were neutropenia cases and 363 (82.9%) were non-neutropenia cases. Patients with neutropenia were younger, had lower levels of initial ANC, white blood cell (WBC) count and C-reactive protein (CRP). Propensity score matching included 75 neutropenia and 247 non-neutropenia patients. No significant difference was found between neutropenia and non-neutropenia groups regarding CALs, coronary artery aneurysms, irregular coronary lumen, IVIG resistance and days of fever duration. There was a non-linear relationship between ΔANC and IVIG resistance. However, threshold effect analysis showed the incidence of IVIG resistance decreased with increasing ΔANC before the turning point (ΔANC = 1.6) (OR = 0.65, 95% CI = 0.50-0.8.4 = 0.001). On the other hand, there was a linear relationship between ΔANC and CALs, even after adjusting the confounders (OR = 1.06, 95% CI = 1.02-1.11, = 0.008). Neutropenia after IVIG was not exactly associated with the outcomes. However, ΔANC was in relation to CALs and IVIG resistance.
研究疾病过程中伴有和不伴有中性粒细胞减少症的患者冠状动脉病变（CALs）及静脉注射免疫球蛋白（IVIG）抵抗的结局，并探讨绝对中性粒细胞计数变化量（ΔANC）与结局之间的关系。我们回顾性分析了2019年1月至2019年12月在苏州大学附属儿童医院住院且主要诊断为川崎病（KD）患者的病历。采用1:4倾向评分匹配法调整基线特征。进行平滑曲线分析和阈值效应分析以揭示ΔANC与结局之间的关系。在纳入的438例患者中，75例（17.1%）为中性粒细胞减少症病例，363例（82.9%）为非中性粒细胞减少症病例。中性粒细胞减少症患者年龄更小，初始ANC、白细胞（WBC）计数和C反应蛋白（CRP）水平更低。倾向评分匹配纳入了75例中性粒细胞减少症患者和247例非中性粒细胞减少症患者。中性粒细胞减少症组与非中性粒细胞减少症组在CALs、冠状动脉瘤、冠状动脉管腔不规则、IVIG抵抗及发热持续天数方面未发现显著差异。ΔANC与IVIG抵抗之间存在非线性关系。然而，阈值效应分析显示，在转折点（ΔANC = 1.6）之前，IVIG抵抗的发生率随ΔANC升高而降低（OR = 0.65，95%CI = 0.50 - 0.84，P = 0.001）。另一方面，即使在调整混杂因素后，ΔANC与CALs之间仍存在线性关系（OR = 1.06，95%CI = 1.02 - 1.11，P = 0.008）。IVIG治疗后出现的中性粒细胞减少症与结局并无确切关联。然而，ΔANC与CALs及IVIG抵抗有关。
