目的:本研究旨在开发一种新的评分系统,利用循环白细胞介素(IL)水平来预测中国川崎病(KD)患者对静脉免疫球蛋白(IVIG)的耐药性。我们进一步将此评分系统与以前建立的六种评分方法进行了比较,以评估其预测性能。
方法:对2020年1月至2022年12月在我院心血管内科病房接受治疗的KD患者进行回顾性分析。六个计分系统(Egami,Formosa,原田,小林,兰和杨)进行了分析,根据我们的数据开发了一个新的评分系统。
结果:在我们的研究中,招募了521名KD患者,其中42人(8.06%)被鉴定为对IVIG有抗性。我们的研究表明,IVIG耐药的KD患者发生冠状动脉病变(CAL)的风险增加(P=0.001)。使用各种评分系统对IVIG耐药性的评估显示出不同水平的敏感性和特异性,如下:Egami(38.10%和88.52%),福尔摩沙(95.24%和41.13%),原田(78.57%和43.22%),小林(66.67%和74.95%),Lan(66.67%和73.49%),和杨(分别为69.05%和77.24%)。我们使用sIL-2R的新型评分系统显示出最高的灵敏度和特异性,分别为69.29%和83.91%。分别,和校正曲线表明模型具有良好的预测精度。
结论:我们新开发的使用sIL-2R的评分系统在识别中国KD患者的IVIG耐药方面表现出优异的预测性能。
OBJECTIVE: This study aimed to develop a novel scoring system utilizing circulating interleukin (IL) levels to predict resistance to intravenous immunoglobulin (IVIG) in Chinese patients with Kawasaki disease (KD). We further compared this scoring system against six previously established scoring methods to evaluate its predictive performance.
METHODS: A retrospective analysis was conducted on KD patients who were treated at the cardiovascular medical ward of our institution from January 2020 to December 2022. Six scoring systems (Egami, Formosa, Harada, Kobayashi, Lan and Yang) were analyzed, and a new scoring system was developed based on our data.
RESULTS: In our study, 521 KD patients were recruited, 42 of whom (8.06%) were identified as resistant to IVIG. Our study indicated that IVIG-resistant KD patients were at an increased risk for the development of coronary arterial lesions (CALs) (P = 0.001). The evaluation of IVIG resistance using various scoring systems revealed differing levels of sensitivity and specificity, as follows: Egami (38.10% and 88.52%), Formosa (95.24% and 41.13%), Harada (78.57% and 43.22%), Kobayashi (66.67% and 74.95%), Lan (66.67% and 73.49%), and Yang (69.05% and 77.24%). Our novel scoring system utilizing sIL-2R demonstrated the highest sensitivity and specificity of 69.29% and 83.91%, respectively, and calibration curves indicated a favorable predictive accuracy of the model.
CONCLUSIONS: Our newly developed scoring system utilizing sIL-2R demonstrated superior predictive performance in identifying IVIG resistance among Chinese patients with KD.