川崎病静脉注射免疫球蛋白抵抗评分系统研究进展

doi:10.3877/cma.j.issn.1673-5250.2017.01.018

中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (01) : 99 -104. doi: 10.3877/cma.j.issn.1673-5250.2017.01.018

所属专题：专题评论；文献；

综述

川崎病静脉注射免疫球蛋白抵抗评分系统研究进展

吴美¹, 王川², 华益民², 周开宇²^,^†(

)

^1. 610041　成都，四川大学华西第二医院儿童心血管科，出生缺陷与相关妇儿疾病教育部重点实验室；610041　成都，四川大学华西临床医学院
^2. 610041　成都，四川大学华西第二医院儿童心血管科，出生缺陷与相关妇儿疾病教育部重点实验室

收稿日期:2016-11-10 修回日期:2017-01-05 出版日期:2017-02-01
通信作者: 周开宇

Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease

Mei Wu¹, Chuan Wang², Yimin Hua², Kaiyu Zhou²^,^†()

^1. Department of Pediatric Cardiovascular, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
^2. Department of Pediatric Cardiovascular, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Received:2016-11-10 Revised:2017-01-05 Published:2017-02-01
Corresponding author: Kaiyu Zhou
About author:
Corresponding author: Zhou Kaiyu, Email: kaiyuzhou313@163.com

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引用本文：

吴美, 王川, 华益民, 周开宇. 川崎病静脉注射免疫球蛋白抵抗评分系统研究进展[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(01): 99-104.

Mei Wu, Chuan Wang, Yimin Hua, Kaiyu Zhou. Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(01): 99-104.

自使用大剂量静脉注射免疫球蛋白(IVIG)治疗川崎病以来，川崎病患儿冠状动脉损伤发生率显著下降。但是,10%～20%患儿对首次IVIG治疗发生抵抗，并且这些患儿较IVIG治疗敏感患儿具有更显著冠状动脉损伤趋势。目前已有部分研究对川崎病IVIG抵抗进行系统评分，旨在早期预估川崎病患儿IVIG抵抗，并指导临床治疗。笔者拟就IVIG抵抗评分系统研究进展进行综述。

关键词: 黏膜皮肤淋巴结综合征, 免疫球蛋白类,静脉内, 抵抗评分系统, 儿童

The incidence of coronary artery lesions has decreased since high-dose intravenous immunoglobulin(IVIG) was applied in children with Kawasaki disease. However, almost 10%-20% children with Kawasaki disease has the clinical features of resistance to first dose of IVIG therapy, and they were more likely of suffering from coronary artery lesions than the IVIG responders. There were several resistance score systems to evaluate IVIG resistance in Kawasaki disease, so as to predict and evaluate the response of IVIG therapy in early stage and guide clinical treatment timely. We summarized the literatures and research progress of IVIG resistance score systems in this review.

Key words: Mucocutaneous lymph node syndrome, Immunoglobulins, intravenous, Resistance score system, Child

表1 各地区川崎病静脉注射免疫球蛋白抵抗高危评分系统

文献作者	地区	总样本量(例数)	抵抗组/敏感组(例数/例数)	评分项目	得分(分)	高危与低危分界点
Egami等^[3]	日本东京	320	41/279	年龄<6个月	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为78.0%，特异度为76.0%
?	?	?	?	首次IVIG治疗前发热时间<4 d	1
?	?	?	?	血小板计数<300×10⁹/L	1
?	?	?	?	CRP水平>80 mg/L	1
?	?	?	?	ALT水平>80 IU/L	2
Kobayashi　等^[4]	日本群马	676	148/528	年龄≤12个月	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为86.0%，特异度为68.0%
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	血小板计数≤300×10⁹/L	1
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥80%	2
?	?	?	?	AST水平≥100 IU/L	2
?	?	?	?	Na^＋浓度≤133 mmol/L	2
Sano等^[5]	日本大阪	112	22/90	CRP水平≥70 mg/L	－	包含至少2条为IVIG抵抗高危，ROC曲线敏感度为77.0%，特异度为86.0%
?	?	?	?	AST水平≥200 IU/L	－
?	?	?	?	TB水平≥9 mg/L	－
Moon等^[6]	韩国首尔	91	23/68	首次IVIG治疗前发热时间<5 d	2	≥4分为IVIG抵抗高危，敏感度为74.0%，特异度为71.0%
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥65%	1
?	?	?	?	AST水平≥100 IU/L	1
?	?	?	?	ALT水平≥200 IU/L	1
?	?	?	?	Na^＋浓度≤136 mmol/L	2
Fu等^[7]	中国北京	1 099	200/899	皮疹	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为54.1%，特异度为71.2%
?	?	?	?	肛周改变	1
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	CRP水平≥80 mg/L	2
?	?	?	?	N%≥80%	2
王丽平^[8]	中国上海	624	77/547	血小板计数≤322.50×10⁹/L	0.7	≥1.5分为IVIG抵抗高危，ROC曲线敏感度为83.1%，特异度为57.0%
?	?	?	?	血细胞比容≤29.65%	0.9
?	?	?	?	白蛋白水平≤33.35 g/L	0.8
?	?	?	?	TB水平≥7.75 μmol/L	1.3
Sato等^[9]	日本东京	105	84/21	N%≥75%	2	≥3分为IVIG抵抗高危，ROC曲线敏感度为85.7%，特异度为77.4%
?	?	?	?	IL-6水平≥140 ng/L	2
?	?	?	?	IL-6水平为70～140 ng/L	1
Tremoulet　等^[10]	美国加尼福利亚	362	60/302	首次IVIG治疗前发热时间≤4 d	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为73.3%，特异度为61.9%
?	?	?	?	zHgb水平≤－2.0	1
?	?	?	?	杆状核细胞比例≥20%	2
?	?	?	?	GGT水平≥60 IU/L	1
Lin等^[11]	中国台湾	248	29/219	淋巴结肿大阳性	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为86.2%，特异度为81.3%
?	?	?	?	N%≥60%	2
?	?	?	?	白蛋白水平≤35 g/L	1
Tang等^[12]	中国苏州	910	46/864	年龄<6个月	2	≥4分为IVIG抵抗高危，ROC曲线敏感度为71.4%，特异度为76.0%
?	?	?	?	皮疹	1
?	?	?	?	四肢硬肿	1
?	?	?	?	N%≥80%	1
?	?	?	?	白蛋白水平<35 g/L	2

表1 各地区川崎病静脉注射免疫球蛋白抵抗高危评分系统

文献作者	地区	总样本量(例数)	抵抗组/敏感组(例数/例数)	评分项目	得分(分)	高危与低危分界点
Egami等^[3]	日本东京	320	41/279	年龄<6个月	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为78.0%，特异度为76.0%
?	?	?	?	首次IVIG治疗前发热时间<4 d	1
?	?	?	?	血小板计数<300×10⁹/L	1
?	?	?	?	CRP水平>80 mg/L	1
?	?	?	?	ALT水平>80 IU/L	2
Kobayashi　等^[4]	日本群马	676	148/528	年龄≤12个月	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为86.0%，特异度为68.0%
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	血小板计数≤300×10⁹/L	1
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥80%	2
?	?	?	?	AST水平≥100 IU/L	2
?	?	?	?	Na^＋浓度≤133 mmol/L	2
Sano等^[5]	日本大阪	112	22/90	CRP水平≥70 mg/L	－	包含至少2条为IVIG抵抗高危，ROC曲线敏感度为77.0%，特异度为86.0%
?	?	?	?	AST水平≥200 IU/L	－
?	?	?	?	TB水平≥9 mg/L	－
Moon等^[6]	韩国首尔	91	23/68	首次IVIG治疗前发热时间<5 d	2	≥4分为IVIG抵抗高危，敏感度为74.0%，特异度为71.0%
?	?	?	?	CRP水平≥100 mg/L	1
?	?	?	?	N%≥65%	1
?	?	?	?	AST水平≥100 IU/L	1
?	?	?	?	ALT水平≥200 IU/L	1
?	?	?	?	Na^＋浓度≤136 mmol/L	2
Fu等^[7]	中国北京	1 099	200/899	皮疹	1	≥4分为IVIG抵抗高危，ROC曲线敏感度为54.1%，特异度为71.2%
?	?	?	?	肛周改变	1
?	?	?	?	首次IVIG治疗前发热时间≤4 d	2
?	?	?	?	CRP水平≥80 mg/L	2
?	?	?	?	N%≥80%	2
王丽平^[8]	中国上海	624	77/547	血小板计数≤322.50×10⁹/L	0.7	≥1.5分为IVIG抵抗高危，ROC曲线敏感度为83.1%，特异度为57.0%
?	?	?	?	血细胞比容≤29.65%	0.9
?	?	?	?	白蛋白水平≤33.35 g/L	0.8
?	?	?	?	TB水平≥7.75 μmol/L	1.3
Sato等^[9]	日本东京	105	84/21	N%≥75%	2	≥3分为IVIG抵抗高危，ROC曲线敏感度为85.7%，特异度为77.4%
?	?	?	?	IL-6水平≥140 ng/L	2
?	?	?	?	IL-6水平为70～140 ng/L	1
Tremoulet　等^[10]	美国加尼福利亚	362	60/302	首次IVIG治疗前发热时间≤4 d	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为73.3%，特异度为61.9%
?	?	?	?	zHgb水平≤－2.0	1
?	?	?	?	杆状核细胞比例≥20%	2
?	?	?	?	GGT水平≥60 IU/L	1
Lin等^[11]	中国台湾	248	29/219	淋巴结肿大阳性	1	≥3分为IVIG抵抗高危，ROC曲线敏感度为86.2%，特异度为81.3%
?	?	?	?	N%≥60%	2
?	?	?	?	白蛋白水平≤35 g/L	1
Tang等^[12]	中国苏州	910	46/864	年龄<6个月	2	≥4分为IVIG抵抗高危，ROC曲线敏感度为71.4%，特异度为76.0%
?	?	?	?	皮疹	1
?	?	?	?	四肢硬肿	1
?	?	?	?	N%≥80%	1
?	?	?	?	白蛋白水平<35 g/L	2

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Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease

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Research progress of resistance score systems of intravenous immunoglobulin in children with Kawasaki disease