【摘要】 目的探讨川崎病(KD)冠脉损伤(CAL)的危险因素,以ROC曲线评价各危险因素的预测价值。方法回顾性分析2014年1月至2018年6月收治的204例KD患儿的病例资料,按照是否合并冠脉损伤将其分为观察组和对照组,观察组90例,对照组114例,比较两组临床特征及实验室指标,对KD患儿合并CAL的危险因素进行多因素logistic回归分析,并绘制ROC曲线评估各危险因素的预测价值。结果男性、白细胞计数(WBC)、C反应蛋白(CRP)及降钙素原(PCT)水平与冠脉损伤相关(P<0.05);WBC、CRP及PCT作为早期预测指标的最佳临界值分别为15.9×109/L、59.8 mg/l、2.2 ng/mL,作为单项指标预测的灵敏度和特异度分别为76.7%、71.2%,88.9%、57.9%,82.2%、84.2%;不同指标间联合预测的灵敏度和特异度,WBC+PCT为86.7%、79.8%,WBC+CRP为85.6%、63.2%,PCT+CRP为87.8%、78.9%,三者联合为90.0%、76.3%。结论男性患儿是KD合并CAL的危险因素。观察组WBC、CRP及血清PCT水平高于对照组,三者均可作为早期预测CAL的参考指标;联合检测可以提高预测的准确性和灵敏度。更多还原

【Abstract】 Objective To explore investigate the risk factors of coronary artery injury(CAL) in Kawasaki disease(KD), and to evaluate the predictive value of various risk factors by ROC curve. Methods Retrospective analysis of the medical data of 204 children with KD admitted from January 2014 to June 2018.The patients were classified into two groups according to the presence of CAL: CAL(n=90) and control(n=114). The clinical and laboratory indices were compared between the two groups.The risk factors for the development of CAL in children with KD were identified by multiple logistic regression analysis,and draw the ROC curve to evaluate its predicted value of each risk factor. Results Male,white blood cell(WBC), C-reactive protein(CRP)and procalcitonin( PCT) were dependent of coronary artery dilatation(P<0.05). The best limit of WBC, CRP and PCT for early prediction was 15.9×109/L,59.8 mg/l and 2.2 ng/mL, respectively. The sensitivity and specificity of prediction as single indictor was 76.7%,71.2%,88.9%,57.9%,82.2%、84.2%, respectively; And the sensitivity and specificity of prediction for the combination of WBC and PCT was 86.7% and 79.8%, for WBC+CRP was 85.6% and 63.2%, for PCT+CRP was 87.8% and 78.9%, and for three indictors was 90.0% and 76.3%. Conclusions Male were the risk factors for Kawasaki disease with coronary artery lesions.The levels of WBC, CRP and serum PCT in the observation group were higher than those in the control group. they can be used as a reference indicator of early prediction, and combined detection can improve the accuracy and sensitivity of prediction.更多还原