Kobayashi评分体系在中国川崎病患儿中的临床应用价值

目的探讨在川崎病(Kawasaki disease,KD)初始治疗前,Kobayashi评分体系预测中国KD患儿并发冠状动脉损伤(CAL)的能效。方法回顾性分析113例KD患儿临床资料,将其分为冠状动脉损伤组(CAL组)与非冠状动脉损伤组(NCAL组);应用Kobayashi评分体系对所有患儿评分,用χ2检验分析各评分参数及依危险程度分组后的CAL发生率有无统计学差异,并分析该评分体系的能效。结果 CAL组43例,NCAL组70例,根据该评分体系分为低危组80例、高危组33例,单因素分析结果显示谷草转氨酶(AST)≥100U/L、外周血中性粒细胞百分比≥80%、C反应蛋白(CRP)≥100mg/L、年龄≤1岁是KD患儿并发CAL的危险因素,Kobayashi评分高危组的CAL发生率明显高于低危组(均P<0.05);该评分体系的灵敏度为0.56、特异度为0.87、符合率Kappa值为0.50。结论 Kobayashi评分体系的7个参数中AST≥100U/L、外周血中性粒细胞%≥80%、CRP≥100mg/L、年龄≤1岁被证明是中国KD患儿并发CAL的危险因素;该评分体系虽然可以预测中国KD患儿是否并发CAL,但能效不高。

Clinical Values of Kobayashi Scoring System in Chinese Children with Kawasaki Disease

Objective To investigate the energy efficiency of Kobayashi scoring system to identify the Chinese children complicated with coronary artery lesions(CAL)from Kawasaki disease(KD)children before initial treatment.Methods The clinical data of 113 cases of KD were retrospectively analyzed,and divided into CAL group and non-CAL group.Kobayashi scoring system was applied to score for all patients,and the χ2 tests were used to compare CAL incidence between the scoring parameters respectively and the two risk groups.The energy efficiency of Kobayashi scoring system was analyzed.Results There were 43 cases in CAL group,and 70 cases in non-CAL group,and according to the scoring system,80 cases were divided into low-risk group,and 33 cases into high-risk group.Single factor analysis showed that AST ≥ 100 U/L,neutrophil ≥ 80%,CRP ≥ 100 mg/L,aged ≤ 1-year-old were the risk factors of CAL in KD children.The CAL incidence in high-risk group was significantly higher than in low-risk group(all P<0.05).The sensitivity,specificity and Kappa value of the Kobayashi scoring system was 0.56,0.87,and 0.50 respectively.Conclusion Among the seven parameters of Kobayashi scoring system,AST ≥ 100 U/L,neutrophil ≥ 80%,CRP ≥ 100 mg/L,and aged ≤ 1-year-old were proved to be the risk factors of CAL in Chinese KD patients.The scoring system had ability to predict the CAL in KD patients,but the energy efficiency was not high enough.