Welcome to visit Zhongnan Medical Journal Press Series journal website!

Home Articles Vol 28,2024 No.2 Detail

Factors affecting the efficacy of intravenous gammaglobulin combined with aspirin in the treatment of Kawasaki disease and the construction of a prediction model

Published on Nov. 08, 2024Total Views: 370 times Total Downloads: 36 times Download Mobile

Author: ZHA Meibao LIU Xiaoling

Affiliation: Department of Pediatrics, Anqing First People's Hospital of Anhui Medical University, Anqing 246000, Anhui Province, China

Keywords: Kawasaki disease Therapeutic effect Influencing factors Prediction model Immunoglobulin Nomogram aspirin

DOI: 10.12173/j.issn.2097-4922.202407162

Reference: ZHA Meibao, LIU Xiaoling.Factors affecting the efficacy of intravenous gammaglobulin combined with aspirin in the treatment of Kawasaki disease and the construction of a prediction model[J].Yaoxue QianYan Zazhi,2024, 28(2):221-228.DOI: 10.12173/j.issn.2097-4922.202407162.[Article in Chinese]

  • Abstract
  • Full-text
  • References
Abstract

Objective  To explore the influencing factors of the therapeutic effect of intravenous immunoglobulin (IVIG) combined with aspirin (ASP) in the treatment of Kawasaki disease (KD).

Methods  The clinical data of children with KD who were treated in the Department of Pediatrics of Anqing First People's Hospital of Anhui Medical University from June lst, 2021 to May 31, 2024 were retrospectively analyzed. They were divided into the effective group and the ineffective group according to the therapeutic effect. Univariate analysis was used to explore the differences in clinical characteristics between the two groups. Multivariate Logistic regression analysis was used to explore the independent risk factors for ineffective treatment in children with KD, and the Nomogram was constructed using R software. Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the discriminatory ability, calibration degree, and clinical benefit of the Nomogram, respectively.

Results  A total of 80 children with KD were included in this study, with 59 cases in the effective group and 21 cases in the ineffective group. Univariate analysis showed that there were significant statistical differences in fever duration, IVIG resistance (IVIGR), gastrointestinal bleeding, procalcitonin (PCT), C-reaction protein (CRP), interleukin-6 (IL-6), albumin (ALB) and erythrocyte sedimentation rate (ESR) between the two groups (P<0.05). In addition, there was no statistical significance in the comparisons of age, gender, body-mass index, average monthly family income, premature infants, coronary artery lesions and respiratory tract infection between the two groups (P>0.05). The results of multivariate Logistic regression showed that IVIGR (yes), PCT (≥0.96 ng/mL), CRP (≥41.98 mg/L), ALB (≤30.74  g/L) and ESR (≥17.92 mm/h) were independent risk factors for ineffective treatment in children with KD. ROC analysis showed that the area under the curve of the Nomogram for predicting ineffective treatment in children with KD was 0.989; the calibration curve suggested that the predicted probability of the Nomogram was approximately consistent with the actual probability, and the DCA suggested that when the risk threshold of the Nomogram was 0.912, the clinical net benefit of using the Nomogram was higher than that of not using the Nomogram model.

Conclusion  IVIGR (yes), PCT (≥0.96 ng/mL), CRP (≥41.98 mg/L), ALB (≤30.74 g/L), and ESR (≥17.92 mm/h) can be used to predict poor efficacy in children with KD.

Full-text
Please download the PDF version to read the full text: download
References

1.朱美玉, 王进荣, 刘桂芸, 等. 静脉留置针留置时间对川崎病患儿大剂量静脉注射人免疫球蛋白致静脉损伤的影响[J]. 护理实践与研究, 2023, 20(18): 2826-2830. [Zhu MY, Wang JR, Liu GY, et al. Effect of intravenous indwelling needle retention time on venous injury caused by high-dose intravenous human immunoglobulin in children with Kawasaki disease[J]. Nursing Practice and Research, 2023, 20(18): 2826-2830.] DOI: 10.3969/j.issn.1672-9676.2023.18.025.

2.李婧, 陈杰. 川崎病与肠道菌群[J]. 国际检验医学杂志, 2023, 44(7): 875-880. [Li J, Chen J. Kawasaki disease and the intestinal microbiota[J]. International Journal of Laboratory Medicine, 2023, 44(7): 875-880.] DOI: 10.3969/j.issn.1673-4130.2023.07.021.

3.赵分分, 柴娜娜, 赵欢欢. 丙种球蛋白联合阿司匹林在川崎病合并冠脉扩张患儿治疗中的效果观察[J]. 数理医药学杂志, 2022, 35(2): 269-271. [Zhao FF, Chai NN, Zhao HH. The effect of gamma globulin and aspirin in the treatment of children with Kawasaki disease with coronary dilation[J]. Journal of Mathematical Medicine, 2022, 35(2): 269-271.] DOI: 10.3969/j.issn.1004-4337.2022.02.037.

4.方莹, 宋青青, 刘婷. 川崎病患儿延迟就医现状及影响因素分析[J]. 护理实践与研究, 2023, 20(5): 665-668. [Fang Y, Song QQ, Liu T. Analysis of the status and influencing factors of delayed medical treatment in children with Kawasaki disease[J]. Nursing Practice and Research, 2023, 20(5): 665-668.] DOI: 10.3969/j.issn.1672-9676.2023.05.007.

5.查旋, 许周媚. 免疫球蛋白输注速度对川崎病患儿的疗效和安全性比较[J]. 中国药师, 2024, 27(7): 1149-1154. [Zha X, Xu ZM. Comparison of the efficacy and safety of immunoglobulin infusion speed in children with Kawasaki disease[J]. China Pharmacist, 2024, 27(7): 1149-1154.] DOI: 10.12173/j.issn.1008-049X.202404053.

6.朱佳聪, 张旭. 川崎病患儿静脉注射免疫球蛋白抵抗的影响因素评估及IVIGR风险预测模型构建[J]. 中国药师, 2024, 27(3): 415-422. [Zhu JC, Zhang X. Evaluation of factors influencing intravenous immunoglobulin resistance and IVIGR risk prediction model construction in children with Kawasaki disease[J]. China Pharmacist, 2024, 27(3): 415-422.] DOI: 10.12173/j.issn.1008-049X.202401069.

7.侯宁宁, 李静, 古开心. 人免疫球蛋白冲击疗法在川崎病患儿中的治疗效果分析[J]. 医学理论与实践, 2023, 36(4): 638-640. [Hou NN, Li J, Gu KX. Analysis of the therapeutic efficacy of human immunoglobulin shock therapy in children with Kawasaki disease[J]. Medical Theory and Practice, 2023, 36(4): 638-640.] DOI: 10.19381/j.issn.1001-7585.2023.04.037.

8.易贤红, 方丽琴, 李建木. 糖皮质激素联合人免疫球蛋白治疗川崎病患儿的疗效及对外周血Th1/Th2和GDF-15水平的影响[J]. 中国医院用药评价与分析, 2023, 23(2): 174-177. [Yi XH, Fang LQ, Li JM. Efficacy of glucocorticoids plus human immunoglobulin and effects on peripheral Th 1/Th 2 and GDF-15 levels in children with Kawasaki disease[J]. Evaluation and Analysis of Hospital Use in China, 2023, 23(2): 174-177.] DOI: 10.14009/j.issn.1672-2124.2023.02.009.

9.成晓燕, 任永勤. 不同剂量人免疫球蛋白联合阿司匹林治疗小儿川崎病的效果及对血管内皮功能、氧化应激指标的影响[J]. 临床医学研究与实践, 2024, 9(16): 112-116. [Cheng XY, Ren YQ. Effect of different doses of human immunoglobulin combined with aspirin in treating pediatric Kawasaki disease and its effects on vascular endothelial function and oxidative stress indicators[J]. Clinical Medicine Research and Practice, 2024, 9(16): 112-116.] DOI: 10.19347/j.cnki.2096-1413.202416026.

10.McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American heart association[J]. Circulation, 2017, 135(17): e927-e999. DOI: 10.1161/CIR.0000000000000484.

11.Wang S, Ding C, Zhang Q, et al. A novel model for predicting intravenous immunoglobulin-resistance in Kawasaki disease: a large cohort study[J]. Front Cardiovasc Med, 2023, 10: 1226592. DOI: 10.3389/fcvm.2023.1226592.

12.Han SB, Lee SY. Macrophage activation syndrome in children with Kawasaki disease: diagnostic and therapeutic approaches[J]. World J Pediatr, 2020, 16(6): 566-574. DOI: 10.1007/s12519-020-00360-6.

13.黄红艳, 白玉, 杨琳东. 阿司匹林联合丙种球蛋白治疗川崎病的效果预测及影响因素分析[J]. 中国妇幼健康研究, 2022, 33(7): 104-108. [Huang HY, Bai Y, Yang LD. Prediction of aspirin and combination of gamma globulin in Kawasaki disease and analysis of influencing factors[J]. China Maternal and Child Health Research, 2022, 33(7): 104-108.] DOI: 10.3969/j.issn.1673-5293.2022.07.019.

14.王从贵, 彭海琳, 熊伟. 血清多配体蛋白聚糖1、血管紧张素转换酶2与川崎病患儿冠状动脉损害和临床疗效的关系[J]. 广东医学, 2024, 45(6): 666-671. [Wang  CG, Peng HL, Xiong W. The relationship between serum multiligand proteoglycan 1 and angiotensin-converting enzyme 2 and coronary artery damage and clinical efficacy in children with Kawasaki disease[J]. Guangdong Medicine, 2024, 45(6): 666-671.] DOI: 10.13820/j.cnki.gdyx.20234007.

15.谭雪松, 张太海, 罗红平, 等. 丙种球蛋白对小儿川崎病的疗效及影响因素分析[J]. 河北医药, 2021, 43(15): 2334-2336, 2340. [Tan XS, Zhang TH, Luo HP, et al. Analysis of the efficacy and influencing factors of gamma globulin in pediatric Kawasaki disease [J]. Hebei Medicine, 2021, 43(15): 2334-2336, 2340.] DOI: 10.3969/j.issn.1002-7386.2021.15.022.

16.Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 Guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. DOI: 10.1253/circj.CJ-19-1094.

17.徐丹, 潘冬宁, 李亚琴. 川崎病患儿血清五聚蛋白-3水平对静脉注射免疫球蛋白抵抗的影响和预测价值[J]. 临床儿科杂志, 2023, 41(7): 502-506. [Xu D, Pan DN, Li YQ. Effect and predictive value of serum pentameric protein-3 levels on intravenous immunoglobulin resistance in children with Kawasaki disease[J]. Journal of Clinical Pediatrics, 2023, 41(7): 502-506.] DOI: 10.12372/jcp.2023.22e1119.

18.成晓燕, 任永勤. 不同剂量人免疫球蛋白联合阿司匹林治疗小儿川崎病的效果及对血管内皮功能、氧化应激指标的影响[J]. 临床医学研究与实践, 2024, 9(16): 112-116. [Cheng XY, Ren YQ. Effect of different doses of human immunoglobulin combined with aspirin in treating pediatric Kawasaki disease and its effects on vascular endothelial function and oxidative stress indicators[J]. Clinical Medicine Research and Practice, 2024, 9(16): 112-116.] DOI: 10.19347/j.cnki.2096-1413.202416026.

19.郑丽君, 张淑平, 吴梦. 丙种球蛋白输注对川崎病患儿外周血CD4+CD25+调节T细胞与淋巴细胞亚群分布的影响[J]. 免疫学杂志, 2017, 33(11): 991-995. [Zheng LJ, Zhang SP, Wu M. Effect of gamma globulin infusion on the distribution of CD4+CD25+regulatory T cells and lymphocytes in peripheral blood of children with Kawasaki disease [J]. Journal of Immunology, 2017, 33(11): 991-995.] DOI: 10.13431/j.cnki.immunol.j.20170173.

20.Ma YJ, He M, Han JA, et al. A clinical study of HBsAg‐activated dendritic cells and cytokine‐induced killer cells during the treatment for chronic hepatitis B[J]. Scand J Immunol, 2013, 78(4): 387-393. DOI: 10.1111/sji.12097.

21.Gamez-Gonzalez LB, Moribe-Quintero I, Cisneros-Castolo M, et al. Kawasaki disease shock syndrome: unique and severe subtype of Kawasaki disease[J]. Pediatr Int, 2018, 60(9): 781-790. DOI: 10.1111/ped.13614.

22.Yang X, Li J, Liu J, et al. Relationship of Treg/Th17 balance with HBeAg change in HBeAg-positive chronic hepatitis B patients receiving telbivudine antiviral treatment: a longitudinal observational study[J]. Medicine (Baltimore), 2017, 96(23): e7064. DOI: 10.1097/MD.0000000000007064.

Popular papers
Last 6 months