2023 年第 10 期 第 18 卷

川崎病患儿阿司匹林抵抗发生情况及高危因素分析

Analysis of the incidence and risk factors of aspirin resistance in children with Kawasaki disease

作者：郑雨濛郑奎郝京霞李博张英谦

英文作者：Zheng Yumeng Zheng Kui Hao Jingxia Li Bo Zhang Yingqian

单位：河北省儿童医院心内科河北省小儿心血管重点实验室，石家庄050031

英文单位：Department of Cardiology Hebei Children′s Hospital Key Laboratory of Pediatric Cardiovascular of Hebei Province Shijiazhuang 050031 China

关键词：川崎病；阿司匹林抵抗；血栓弹力图；高危因素

英文关键词：Kawasakidisease;Aspirinresistance;Thromboelastography;Riskfactors

• 摘要：

• 目的  分析川崎病患儿阿司匹林抵抗（AR）发生情况及高危因素。方法  收集2018年1月至2022年6月就诊于河北省儿童医院心内科的90例川崎病患儿，根据患儿是否存在阿司匹林抵抗分为AR组（15例）和阿司匹林敏感（AS）组（75例）。比较2组患儿基线资料、实验室及影像学指标。采用多因素Logistic回归分析法分析川崎病患儿AR的危险因素。采用受试者工作特征（ROC）曲线分析各指标对川崎病患儿AR的预测价值。结果  2组患儿性别、年龄、临床表现、并发症、用药情况比较，差异均无统计学意义（均P＞0.05）。AR组患儿三酰甘油、丙氨酸转氨酶水平、R值均高于AS组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示丙氨酸转氨酶（比值比=1.086，95%置信区间：1.040～1.135，P＜0.001）和R值（比值比=1.443，95%置信区间：1.044～1.944，P=0.026）是AR的独立危险因素。ROC曲线分析结果显示，R值和丙氨酸转氨酶预测AR的曲线下面积分别为0.703和0.949，最佳截断值分别为4.95和68.5 U/L，敏感度分别为71.4%和93.3%，特异度分别为69.4%和89.0%。结论  丙氨酸转氨酶、R值是川崎病患儿发生AR的独立危险因素，其对川崎病AR的早期诊断和识别尤为关键。

• Objective  To investigate the prevalence and risk factors of aspirin resistance (AR) in children with Kawasaki disease. Methods  A total of 90 children with Kawasaki disease who were admitted to Department of Cardiology, Hebei Children′s Hospital from January 2018 to June 2022 were collected. According to whether the patients had aspirin resistance, they were divided into AR group (15 cases) and aspirin sensitive (AS) group (75 cases). The two groups were compared in terms of baseline data, laboratory and imaging parameters. Multivariate Logistic regression analysis was used to analyze the risk factors of AR in children with Kawasaki disease. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of each index for AR in children with Kawasaki disease. Results  There were no significant differences in gender, age, clinical manifestations, complications and medication between the two groups (all P>0.05). The levels of triglyceride, alanine aminotransferase and R value in AR group were higher than those in AS groups (all P<0.05). Multivariate Logistic regression analysis showed that alanine aminotransferase (odds ratio=1.086, 95% confidence interval: 1.040-1.135, P<0.001) and R value (odds ratio =1.443, 95% confidence interval: 1.044-1.944, P=0.026) were independent risk factors for AR. ROC curve analysis showed that the area under the curve of R value and alanine aminotransferase for predicting AR was 0.703 and 0.949, the best cut-off value was 4.95 and 68.5 U/L, the sensitivity was 71.4% and 93.3%, and the specificity was 69.4% and 89.0%, respectively. Conclusion  Alanine aminotransferase and R value are independent risk factors for AR in Kawasaki disease, which are particularly critical for early diagnosis and recognition of AR in Kawasaki disease.