李敏,邵晓珊
LI Min,SHAO Xiaoshan

• 1:遵义医科大学第一临床学院
• 2:贵阳市妇幼保健院肾脏风湿免疫科

摘要(Abstract)：

目的 探讨急性期外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及平均血小板体积与淋巴细胞比值（MPVLR）对完全川崎病（cKD）冠状动脉扩张（CAL）、丙种球蛋白（IVIG）抵抗的预测价值。方法 明确诊断为cKD的277例患儿，根据有无CAL、IVIG耐药与否，分为cKD-CAL组和cKD-non-CAL组、cKD-IVIG耐药组和cKD-IVIG敏感组，收集患者的基础资料，记录急性期IVIG治疗前的中性粒细胞计数（NEUT）、淋巴细胞计数（LYM）、血小板计数（PLT）、平均血小板体积（MPV），计算NLR、PLR及MPVLR；应用受试者工作（ROC）曲线下面积（AUC）评估NLR、PLR及MPVLR对cKD患儿发生CAL、IVIG抵抗的预测价值。结果 CAL组患儿PLT、NLR及PLR高于非CAL组，LYM、MPVLR低于非CAL组，差异均有统计学意义（P<0.05）;IVIG耐药组NEUT、NLR、PLR及MPVLR均高于cKD-IVIG敏感组，LYM则低于敏感组，差异均有统计学意义（P<0.05）;ROC结果显示，NLR预测cKD-CAL及cKD-IVIG抵抗的AUC分别为0.745、0.764, cut-off值分别为2.145、5.81;NLR预测CAL和IVIG抵抗的灵敏度分别为78%、85.8%，特异度分别为63.3%、46.8%;NLR联合PLR对CAL预测的灵敏度和特异度分别提高至79%和81.4%，但对预测IVIG抵抗的预测价值并未提高；单用MPVLR对CAL和IVIG抵抗基本无预测价值。结论 NLR在急性期IVIG治疗前对cKD发生CAL和IVIG抵抗具有一定的预测价值，NLR联合PLR对CAL的预测价值优于单一指标检测。
Objective To investigate the predictive value of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio( PLR), and mean platelet volume to lymphocyte ratio( MPVLR) for coronary artery lesion(CAL) and IVIG resistance with complete Kawasaki disease(cKD) in acute phrase.Methods Two hundred and seventy-seven patients with cKD were divided into CAL group(cKD with CAL), nonCAL group( cKD without CAL), and IVIG resistance group, and IVIG sensitivity group. The general conditions, neutrophil count( NEUT), lymphocyte count( LYM),platelet count(PLT), mean platelet volume(MPV),NLR, PLR, and MPLR were compared among the groups. The predictive values of NLR, PLR and MPVLR for cKD and IVIG resistance were evaluated by ROC curve.Results The PLT, NLR, and PLR of cKD-CAL patients were higher than those of the nonCAL group, the MPVLR and LYM were lower in the nonCAL group, and the difference was statistically significant(P< 0. 05). The NEUT, NLR, PLR, and MPVLR in IVIG resistance group were higher than those in cKD-IVIG group, LYM was lower in IVIG sensitivity group, and the difference was statistically significant(P< 0. 05). The areas under ROC curve of PLR for predicting cKD-CAL, cKD-IVIG were 0. 745 and 0. 764, the cut-off values of NLR were 2. 145 and 5. 81,respectively, while the values of cure sensitivity were 78% and 85. 8% respectively, and the values of specificity were 63. 3% and 46. 8% respectively(P< 0. 05). The sensitivity and specificity values of NLR combined with PLR for predicting CAL increased to 79% and 81. 4%, respectively. However,the MPVLR alone had no ability to predict the occurrence of CAL and IVIG resistance.Conclusion The NLR has certain clinical value in predicting the occurrence of CAL and IVIG resistance in cKD patients before IVIG treatment in acute phase, and the combination of high NLR and PLR was a stronger predicator than either alone in patients with cKD.

关键词(KeyWords)： 川崎病;冠状动脉病变;中性粒细胞与淋巴细胞比值;血小板与淋巴细胞比值;平均血小板体积与淋巴细胞;预测价值
kawasaki disease (KD);coronary artery lesion (CAL);neutrophil to lymphocyte ratio (NLR);platelet to lymphocyte ratio (PLR);mean platelet volume to lymphocyte ratio (MPVLR);prediction value

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生健康委科学技术基金项目（gzwjkj2019-1-006）

作者(Author): 李敏,邵晓珊
LI Min,SHAO Xiaoshan

DOI: 10.19367/j.cnki.2096-8388.2022.03.013

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