关键词: 黏膜皮肤淋巴结综合征, 丙种球蛋白耐药, 危险因素, 预测模型, ROC曲线

Abstract: Background　At present Kawasaki disease （KD） has become the leading cause of acquired heart disease in children.Although intravenous immunoglobulin （IVIG） combined with aspirin were commonly adopted as the standard therapy protocol in KD which can effectively decrease the incidence of coronary artery lesions （CALs），some KD patients are resistant to IVIG therapy and they are at higher risk of developing CALs than patients who response to IVIG therapy.Therefore，it is very important to predict IVIG-resistance indicators in patients with KD.Objective　To analyze the risk factors of IVIG resistance in KD，develop a new predictive model to identify IVIG resistance，and evaluate the efficacy of the new predictive model compared with other four existing predictive models（Egami，Kobayashi，Fu and Lin）.Methods　A retrospective analysis was made on the clinical data of 173 KD children diagnosed，treated and followed up in Jiangxi Provincial Children's Hospital from January 2016 to June 2018.The patients were divided into IVIG resistant group and IVIG response group.Multivariate Logistic regression was used to analyze the independent risk factors of IVIG resistance.A new predictive model was established by assignment.Four other predictive models were used to evaluate the subjects.The predictive efficacy of the new model was compared with the other four predictive models through the receiver operating characteristic （ROC） curve.Results　Of the 173 cases with KD，31 cases（17.9%）were IVIG resistance and 142（82.1%）were IVIG response.Compared with the IVIG response group，IVIG resistance group had significantly higher percentage of male and higher white blood cell count （WBC），neutrophil count （N），percentage of neutrophils ，C-reactive protein （CRP） and ferritin （SF） levels and lower serum sodium level（P<0.05）.Multivariable Logistic regression analysis showed that male〔OR=5.151，95%CI（1.583，16.756）〕，CRP〔OR=1.166，95%CI（1.070，1.272）〕，sodium level〔OR=0.837，95%CI（0.719，0.914）〕 and SF〔OR=1.192，95%CI（1.079，1.318）〕 were independent risk factors of IVIG resistance in KD（P<0.05）.The cut-off values of each indicator were calculated by ROC curve.The results showed that the cut-off values of CRP，blood Na and SF were 94 mg/L，135 mmol/L and 148 μg/L，respectively.Taking 4 point as the cut off value，and the sensitivity and specificity were 79.9% and 53.3%.The sensitivity and specificity of the Egami model for the data were 38.7% and 73.8%，respectively.The sensitivity and specificity of the Kobayashi model were 35.5% and 88.7%，respectively.The sensitivity and specificity of the Fu model were 48.4% and 78.7%，respectively.The sensitivity and specificity of the Lin model are 77.4% and 55.3%，respectively.Conclusion　Male，sodium，CRP and SF are independent risk factors of IVIG resistance in KD.The new predictive model have a higher sensitivity and prediction efficacy than models of Egami，Kobayashi，Fu and Lin.

Key words: Mucocutaneous lymph node syndrome, Intravenous immunoglobulin resistance, Risk factors, Predictive models, ROC curve