心率变异性、心率减速力与静脉注射免疫球蛋白无反应川崎病的相关性

目的:探讨川崎病(KD)患儿急性期心率变异性(HRV)、心率减速力(DC)与静脉注射免疫球蛋白(IVIG)无反应KD的关系。方法:纳入2015年8月至2019年5月成都市妇女儿童中心医院收治的临床资料完整的KD患儿679例进行前瞻性队列研究，选择同期进行健康体检儿童150例为健康对照组。根据接受初始IVIG治疗14 d...

Correlation of heart rate variability and heart rate deceleration capacity with intravenous immunoglobulin-resistant Kawasaki disease

Objective To investigate the relationship of heart rate variability(HRV),heart rate deceleration capacity(DC)and intravenous immunoglobulin(IVIG)-resistant Kawasaki disease(KD)in children with the acute stage of KD.Methods A total of 679 patients with KD in Chengdu Women and Children′s Central Hospital from August 2015 to May 2019 were selected.In healthy control group,150 children obtained physical examination at the same time.Prospective cohort study was applied to analyze the data.According to the effect of initial IVIG treatment within 14 days,patients were divided into IVIG-sensitive group and IVIG-resistant group.General clinic information,HRV,DC,blood routine,liver function,cardiac troponin I(cTnI),N-terminal pro-B-type natriuretic peptide(NT-proBNP),high sensitivity C-reactive protein(hs-CRP)and erythrocytesedimentation rate(ESR)before initial IVIG treatment of the 2 groups were compared.Multivariate Logistic regression was applied to analyze the risk factors of IVIG-resistant KD.Results Among 679 KD patients,3 cases were lost,among the rest 676 cases,586 cases were in IVIG-sensitive group,and 90 cases were in IVIG-resistant group.The HRV and DC indexes of IVIG-sensitive group and IVIG-resistant group were lower than those of the healthy control group,and the differences among the 3 groups were statistically significant(all P<0.05).Meanwhile,standard deviation of N-N intervals(SDNN)[(65.84±38.22)ms vs.(82.56±21.41)ms,P=0.004],and low frequency(LF)[(192.59±114.10)ms2vs.(258.18±162.75)ms2,P=0.048]of IVIG-resistant group were lower than those of IVIG-sensitive group.White blood cell(WBC),platelets(PLT),hs-CRP,ESR,alanine aminotransferase(ALT),cTnI and NT proBNP in IVIG sensitive group and IVIG-resistant group were all higher than those in the healthy control group(all P<0.05).Further more,ESR[(90.32±37.91)mm/1 h vs.(65.81±25.34)mm/1 h,P=0.019],cTnI[(0.83±0.35)μg/L vs.(0.52±0.18)μg/L,P=0.037]and NT-proBNP[(854.64±293.02)ng/L vs.(584.95±177.11)ng/L,P=0.011]in IVIG-resistant group were higher than those of IVIG-sensitive group.Multivariate Logistic regression analysis demonstrated that SDNN(OR=0.783,95%CI:0.0341-0.979,P=0.021),and NT-proBNP(OR=1.195,95%CI:1.061-1.428,P=0.34)were independent risk factors for predicting IVIG-resistant KD.Conclusions SDNN and NT-proBNP may be independent predictors of IVIG-resistant KD.