| ObjectiveTo identify the affecting factors of the sensitivity to high-dose intravenous immunoglobulin(IVIG)in the treatment of Kawasaki disease(KD)and analyze the potential predictive value of EBV-IgM for IVIG sensitivity in children with KD.MethodsAccording to IVIG sensitivity,children with KD were divided into sensitive group and drug-resistant group.The clinical data,general laboratory data and the serum EBV-IgM results of the children with KD were analyzed by single factor analysis;the multi-factor Logistic analysis was used to clarify theinfluence of the serum EBV-IgM on IVIG sensitivity.A prediction model of IVIG sensitivity in KD children was established,and the predictive value of serum EBV-IgM on IVIG sensitivity was observed.Results1.A total of 353 children(174 males and 179 females)were enrolled in this study.One hundred and eleven patients(31.4%)aged below 12 months and 242 patients(68.6%)over 12months.All patients were accompanied by fever,of whom 65 patients(18.4%)presented with lasting fever limited to less than 5 days,251 patients(71.1%)had fever lasting for 5 to 10days,37 patients(10.5%)had lasting fever for more than 10 days.Among all patients,274cases(77.6%)had skin rashes,342 cases(96.9%)had cervical lymph node enlargement,327cases(92.6%)presented with limb end changes,332 cases(94.1%)had eye conjunctival changes,343 cases(97.2%)had oral mucosa changes,285 cases(80.7%)had erythema reappearance in Bacillus Calmette-Guerin(BCG)inoculation place,256 cases(72.5%)showed flush at perineum area,59 cases(16.7%)were EBV-IgM positive.2.After IVIG’s administration,41(11.6%)children were resistant to IVIG,and 312(88.4%)children were sensitive to IVIG.The clinical data of the children in the sensitive group and the drug-resistant group were compared,respectively.The difference between gender(χ2=4.585,P<0.05)and age(χ2=6.467,P<0.05)was statistically significant.The serum EBV-IgM positive rate of children with KD was 10.3%in the sensitive group and65.9%in the drug resistance group,respectively,and the difference was statistically significant(χ~2=80.467,P<0.05).There were no significant differences among the changes of ocular conjunctival,oral mucosa,BCG scar erythema reappearance,flushing of the perineum area,the duration of fever,skin rashes,cervical lymphadenopathy as well as limb end(P>0.05).The difference of laboratory examination data of children in the sensitive group and drug-resistant group,including platelet counts(PLT)(z=-7.095,P<0.05),erythrocyte sedimentation rate(ESR)(z=-5.124,P<0.05),neutrophil count(N)(t=-5.265,P<0.05),white blood cells count(WBC)(t=-7.004,P<0.05),neutrophil proportion(N%)(t=-4.230,P<0.05),hemoglobin(Hb)(t=2.054,P<0.05),c-reactive protein(CRP)(z=-2.072,P<0.05),procalcitonin(PCT)(z=-2.130,P<0.05),the serum albumin(Alb)(t=3.089,P<0.05),and the serum alanine amino transferase(ALT)(z=-8.202,P<0.05),was all statistically significant.Multivariate stepwise logistic regression analysis was performed on indicators with significant differences in univariate analysis.EBV-IgM positive[OR=3.455,95%CI(1.418,8.421)],PLT<451×10~9/L[OR=0.996,95%CI(0.994,0.998)],WBC>16.01×10~9/L[OR=1.270,95%CI(1.156,1.395)],ALT>158U/L[OR=1.005,95%CI(1.001,1.010)]was an independent risk factor for IVIG resistance(P<0.05).3.IVIG resistance prediction model was established and the regression coefficients based on multivariate analysis were assigned in following:EBV-IgM positive=2 points,PLT<451×109/L=4 points,WBC>16.01×109/L=2 points,ALT>158U/L=4 points.The best cutoff value is 6 points,so the prediction sensitivity is 75.61%and the specificity is 78.21%.Conclusions1.PLT、WBC、EBV-IgM and ALT are independent risk factors affecting IVIG sensitivity in children with KD.2.EBV-IgM combining with PLT,WBC and ALT can be used to predict of the IVIG sensitivity in children with KD. |
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