摘要
目的探讨川崎病患儿预后不良影响因素,建立logistic回归预测模型并进行验证,为临床早期制定干预方案提供指导。方法回顾性选取2021年2月至2023年2月郑州市第七人民医院收治的160例川崎病患儿为研究对象,依据治疗后1个月预后情况分为预后不良组55例、预后良好组105例。比较两组临床资料并分析预后不良的影响因素。基于影响因素建立logistic回归预测模型,以曲线下面积(AUC)、净重新分类指数(NRI)、综合判别改善指数(IDI)评价该模型对预后的预测效能。结果静脉注射免疫球蛋白(IVIG)治疗延迟、发热持续时间≥10 d、IVIG治疗无反应、红细胞分布宽度(RDW)及血清C反应蛋白(CRP)、心肌肌钙蛋白I(cTnI)、细胞间黏附分子-1(ICAM-1)、白细胞介素-6(IL-6)水平为预后不良独立危险因素,25-羟基维生素D_(3)[25-(OH)D_(3)]水平为预后不良的独立保护因素(P<0.05);以发热持续时间≥10 d、IVIG治疗延迟、IVIG治疗无反应、RDW、CRP、cTnI为模型1,以发热持续时间≥10 d、IVIG治疗延迟、IVIG治疗无反应、RDW、CRP、cTnI、IL-6、ICAM-1、25-(OH)D_(3)为模型2,模型1、模型2预测预后不良发生的AUC分别为0.813、0.915,模型2预测模型的AUC大于模型1,且模型2预测效果较模型1明显改善(P<0.05)。结论IVIG治疗延迟、发热持续时间≥10 d、IVIG治疗无反应、RDW及血清CRP、cTnI、ICAM-1、IL-6水平为川崎病患儿预后不良发生的独立危险因素,25-(OH)D_(3)水平为预后不良发生的独立保护因素,基于上述影响因素建立logistic回归预测模型,该模型对预后不良发生具有一定预测价值,可为临床筛查高危患儿提供参考,有助于制定个体化防治方案,以降低预后不良发生风险。
Objective To investigate the adverse prognostic factors in children with Kawasaki disease,establish a logistic regression prediction model and verify it,and provide guidance for early clinical intervention.Methods A total of 160 Kawasaki disease children admitted to the 7th People’s Hospital of Zhengzhou from February 2021 to February 2023 were retrospectively selected as the study objects,and were divided into a poor prognosis group(55 cases)and a good prognosis group(105 cases)according to the prognosis 1 month after treatment.The clinical data of the two groups were compared and the influencing factors of poor prognosis were analyzed.A logistic regression prediction model was established based on the influencing factors,and the predictive efficacy of the model was evaluated by area under the curve(AUC),net reclassification index(NRI)and integrated discrimination improvement(IDI).Results Delay of intravenous immunoglobulin(IVIG)treatment,duration of fever≥10 days,non-response to IVIG treatment,erythrocyte distribution width(RDW),serum C-reactive protein(CRP),cardiac troponin I(cTnI),intercellular adhesion molecule-1(ICAM-1),interleukin-6(IL-6)levels were independent risk factors for poor prognosis.25-hydroxyvitamin D_(3)[25-(OH)D_(3)]level was an independent protective factor for poor prognosis(P<0.05).Duration of fever≥10 days,delay in IVIG treatment,no response to IVIG treatment,RDW,CRP,cTnI were used as model 1,duration of fever≥10 days,delay in IVIG treatment,no response to IVIG treatment,RDW,CRP,cTnI,IL-6,ICAM-1,25-(OH)D_(3)were used as model 2.The AUC of model 1 and model 2 predicting poor prognosis was 0.813 and 0.915,respectively.The AUC of model 2 was greater than that of model 1,and the prediction effect of model 2 was improved compared with model 1(P<0.05).Conclusion Delay of IVIG treatment,duration of fever≥10 days,non-response to IVIG treatment,RDW and serum CRP,cTnI,ICAM-1 and IL-6 levels are independent risk factors for poor prognosis in children with Kawasaki disease,and 25-(OH)D_(3)level is independent protective factor for poor prognosis.Based on the above influencing factors,a logistic regression prediction model was established,which has certain predictive value for the occurrence of poor prognosis,and can provide reference for clinical screening of high-risk children,and help to formulate individualized prevention and treatment plans to reduce the risk of poor prognosis.
作者
王妍
熊亚娟
刘位位
WANG Yan;XIONG Yajuan;LIU Weiwei(Department of Paediatrics,the 7th People’s Hospital of Zhengzhou,Zhengzhou 450000,China)
出处
《河南医学研究》
2025年第1期43-48,共6页
Henan Medical Research
作者简介
通信作者:王妍,E-mail:gj20023@163.com。
