| Objective:1.To study the value of neutrophil-to-lymphocyte ratio(NLR),N-terminal pro-brain natriuretic peptide(NT-pro BNP)and other parameters in the early recognition of intravenous immunoglobulin(IVIG)unresponsive Kawasaki disease before the first IVIG treatment;and study the value of NLR,NT-pro BNP and other parameters in the early identification of IVIG unresponsive Kawasaki disease after 2 days of the first IVIG treatment.2.To study the value of NLR,NT-pro BNP and other parameters before the first IVIG treatment for early identification of coronary artery lesions in patients with Kawasaki disease(KD),and study the value of NLR,NT pro BNP and other parameters in the early recognition of coronary artery lesions in patients with KD after 2 days of the first IVIG treatment.3.Through the analysis of the above correlation parameters,it can help pediatricians to early identify the first time IVIG unresponsive KD and KD children with coronary artery disease,adjust the treatment plan in time(such as choosing steroid hormone as the first choice drug in the initial treatment,together with IVIG and aspirin),at the same time,it can also help pediatricians to evaluate the effect of initial IVIG treatment in time and judge the KD of children to provide basis for further treatment.Methods:The clinical data of 156 children with KD from January 1 month to 14years old in the second hospital of Hebei Medical University from September2017 to December 2020 were retrospectively analyzed.156 children with KD were divided into IVIG responsive group and IVIG resistant group,and then the same 156 children were divided into no coronary artery disease group and coronary artery disease group again.NLR,NT-pro BNP and other related parameters were collected before and 2 days after the first IVIG treatment.IBM SPSS statistics 26.0 software was used to compare the laboratory data of IVIG responsive group and IVIG unresponsive group,no coronary artery disease group and coronary artery disease group.It was found that P<0.05had significant statistical significance.Results:1.When NLR≥3.45 before the first IVIG treatment,the sensitivity and specificity were 62.5%and 71.2%respectively for predicting IVIG unresponsive KD;when C-reactive protein(CRP)≥122.1mg/L before the first IVIG treatment,the sensitivity and specificity were 43.8%and 87.1%respectively for predicting IVIG unresponsive KD;when platelet(PLT)≤291×10~9/L before the first IVIG treatment,the sensitivity and specificity were62.5%and 77%respectively for predicting IVIG unresponsive KD;When hemoglobin(HGB)≤109.5g/L before the first IVIG treatment,the sensitivity and specificity were 68.8%and 61.9%respectively for predicting IVIG unresponsive KD.There were no significant differences in age,gender,aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),serum sodium(Na),erythrocyte sedimentation rate(ESR)and NT-pro BNP between the two groups before the first IVIG treatment,and there was no significant correlation between the two groups.2.When NLR≥1.34 after 2 days of the first IVIG treatment,the sensitivity and specificity of IVIG unresponsive KD were predicted to be64.3%and 84.3%,respectively;when CRP≥15.5mg/L after 2 days of the first IVIG treatment,the sensitivity and specificity of IVIG unresponsive KD were72.7%and 73.5%respectively;when PLT≤489.5×10~9/L after 2 days of the first IVIG treatment,the sensitivity and specificity of IVIG unresponsive KD were predicted to be 92.2%and 52.8%respectively;when HGB≤104.5g/L after 2 days of the first IVIG treatment,the sensitivity and specificity of IVIG unresponsive KD were 71.4%and 72.4%respectively.There were no significant difference in ALB,ALT,AST,Na and NT-pro BNP levels(2 days after the first IVIG treatment)between the IVIG responsive group and the IVIG unresponsive group,and there was no significant correlation between the two groups.3.When the NLR difference(before and 2 days after the first IVIG treatment)ΔNLR≥2.36,the sensitivity and specificity for predicting the initial IVIG unresponsive type were 71.4%and 67.7%respectively.There were no significant difference in the difference of other parametersΔNT-pro BNP,ΔALB,ΔNa,ΔALT,ΔAST,ΔPLT,ΔHGB,ΔCRP(between the first IVIG treatment and 2 days after treatment)between the IVIG responsive group and the IVIG unresponsive group,and there was no significant correlation between the two groups.4.When NT-pro BNP≥816pg/ml before the first IVIG treatment,the sensitivity and specificity of NT-pro BNP in predicting KD complicated with coronary artery disease were 85.7%and 71.0%,respectively.There were no significant differences in age,gender and ALB,Na,ALT,AST,NLR,PLT,HGB and CRP before the first IVIG treatment between the two groups.5.There were no significant differences in NT pro BNP,ALB,Na,ALT,AST,NLR,PLT,HGB and CRP 2 days after the first IVIG treatment between no coronary artery disease group and coronary artery disease group6.When the difference of PLT(before and 2 days after the first IVIG)ΔPLT≥-98.5×10~9/L,the sensitivity and specificity was 86.7%and 58.7%respectively for predicting KD complicated with coronary artery disease.There were no significant difference in the difference of other parametersΔNT-pro BNP,ΔALB,ΔNa,ΔALT,ΔAST,ΔNLR,ΔHGB,ΔCRP(before and 2 days after the first IVIG treatment)between no coronary artery disease group and coronary artery disease group.Conclusion:1.NLR,HGB,PLT,CRP before the first IVIG treatment and NLR,HGB,PLT,CRP 2 days after the first IVIG treatment in KD children have predictive value for IVIG unresponsive KD.The differenceΔNLR between NLR before the first IVIG treatment and 2 days after the first IVIG treatment can also predict IVIG unresponsive KD.In comparison,PLT before the first IVIG treatment and NLR,CRP,PLT and HGB 2 days after the first IVIG treatment may have better effect in predicting unresponsive KD in IVIG.2.NT-pro BNP level before the first IVIG treatment andΔPLT have predictive value for coronary artery disease in KD.The predictive value of NT-pro BNP level before the first IVIG treatment was higher thanΔPLT. |
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