ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2018, Vol. 10 ›› Issue (2): 136-139.doi: 10.3969/j.issn.1674-3865.2018.02.014

• 临床研究 • 上一篇    下一篇

无菌性脓尿预测静脉注射人免疫球蛋白无反应型川崎病及急性期冠脉损伤的应用价值

刘衡，崔玉霞，杨振中   

  1. 550002 贵州 贵阳，贵州省人民医院儿科
  • 出版日期:2018-04-25 发布日期:2018-11-19
  • 通讯作者: 杨振中，E-mail:kcdns@163.com
  • 作者简介:刘衡（1977-），男，医学博士，主治医师。研究方向：儿童血液肿瘤、自身免疫性疾病的诊治

The value of sterile pyuria in predicting intravenous immunoglobulin unresponsive Kawasaki disease and the coronary artery abnormalities during acute phase

LIU Heng, CUI Yuxia, YANG Zhenzhong   

  1.  Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang 550002, China
  • Online:2018-04-25 Published:2018-11-19

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摘要：
目的
总结儿童川崎病无菌性脓尿的临床特点，探讨其预测静脉注射人免疫球蛋白（IVIG）无反应型川崎病及急性期冠脉损伤的应用价值。
方法
选择2010年2月至2016年5月在贵州省人民医院儿科收治的且临床资料完整的川崎病患儿256例，将患儿分为无菌性脓尿组88例与无脓尿组168例。回顾性分析256例川崎病患儿的病历资料，比较并发无菌性脓尿者与无脓尿者实验室与临床资料的差异，绘制ROC曲线寻找预测IVIG无反应型川崎病的最佳截断值。
结果
无菌性脓尿总发生率34.4%（88/256）。无菌性脓尿组IVIG治疗后退热时间、Kobayashi评分、评估为IVIG无反应高风险者（Kobayashi≥5分）百分比、实际IVIG无反应型川崎病发生率均高于无脓尿组，差异有统计学意义（P<0.05）。无菌性脓尿预测IVIG无反应型川崎病的ROC曲线下面积为0.699（95%CI:0.571～0.827，P<0.01），最佳截断值27个/μL，特异性52.2%，敏感性81.0%。两组患儿冠脉损伤发生率分别为20.5%（18/88）与14.3%（24/168），差异无统计学意义（P>0.05）。
结论
无菌性脓尿为川崎病常见表现，尿白细胞＞27个/μL有助于预测IVIG无反应型川崎病，对冠脉损伤发生无明确预测价值

关键词: 川崎病, 无菌性脓尿, IVIG无反应型川崎病, 冠状动脉损伤, 儿童

Abstract:
objective:
To summarize the characteristics of Kawasaki disease(KD) patients with sterile pyuria and to investigate its value in predicting intravenous immunoglobulin(IVIG) unresponsive KD and coronary artery abnormalities(CAA) during acute phase.
Methods:
The records of 256 KD patients with adequate clinical data from February 2010 to May 2016 were retrospectively reviewed. The patients were assigned to non-sterile pyuria group（168 cases） and sterile pyuria group（88 cases）. Laboratory findings and clinical parameters were compared between the two groups. Cutoff value of urine leukocytes count for identifying IVIG-nonresponders was decided by ROC curve.
Results:
Sterile pyuria occurred in 88(34.4%) of the patients. The sterile pyuria group had longer duration of fever, higher average Kobayashi score(KS), higher proportion of children with a high KS(KS≥5) and were more often resistant to IVIG than the non-sterile pyuria group(P<0.05). The area under the ROC curve of urine leukocytes count was 0.699(95% CI: 0.580 to 0.798), with a sensitivity of 81.0% and a specificity of 52.2%. The best cut-off value for identifying IVIG-nonresponders was 27 leukocytes/μL. No statistical differences between the two groups in CAA occurrence were noted(P>0.05).
Conclusion:Sterile pyuria is a common feature of KD. Urine leukocytes count >27/μL might be useful in predicting non-responsiveness to IVIG, but not in predicting the development of CAA in children with KD.

Key words: Kawasaki disease;Sterile pyuria, IVIG unresponsive KD, Coronary artery abnormalities, Child