河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (5): 583-590.doi: 10.3969/j.issn.1007-3205.2025.05.015

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DeRitis比值对小儿川崎病合并冠状动脉损伤的评估意义

  

  1. 河北省儿童医院重症医学二科，河北 石家庄 050031

  • 出版日期:2025-05-25 发布日期:2025-05-23
  • 作者简介:赵俊山（1985-），男，河北邯郸人，河北省儿童医院主治医师，医学硕士，从事小儿免疫、急危重症等临床研究。

  • 基金资助:
    河北省医学科学研究课题计划项目（20231174）

The significance of the DeRitis ratio in the evaluation of coronary artery lesions in pediatric patients with Kawasaki disease

  1. The Second Department of Intensive Care Medicine, Hebei Children′s Hospital, Shijiazhuang 050031, China

  • Online:2025-05-25 Published:2025-05-23

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摘要： 目的 分析DeRitis比值等对小儿典型川崎病（Kawasaki disease， KD）合并冠状动脉损伤（coronary artery lesions，CAL）的评估意义。
方法 收集2022年6月—2024年6月就诊于河北省儿童医院KD患儿96例，根据超声心动图检测结果分组，将出现CAL并发症的患儿定为CAL+组，未出现CAL并发症的患儿定为CAL-组，其中CAL-组61例，合并CAL组35例（包括治疗8周内冠状动脉恢复组23例，治疗8周冠状动脉持续扩张组12例），在KD急性期、临床痊愈期及静注人免疫球蛋白（human immunoglobulin for intravenous injection，IVIG）治疗后8周等阶段，在患儿空腹条件下无菌采集外周静脉血，检测肝功能、心肌酶谱及血清电解质等临床生化检验项目，收集丙氨酸移氨酶（alanine aminotransferase，ALT）、天冬氨酸移氨酶（aspartate aminotransferase，AST）、γ-谷氨酰转肽酶（gamma-glutamyl transpeptidase，GGT）、肌酸激酶（creatine kinase，CK）、肌酸激酶同工酶-MB（creatine kinase isoenzyme MB，CK-MB）、乳酸脱氢酶（lactate dehydrogenase，LDH）及血清钠等指标，并计算DeRitis比值、LDH/AST比值等并统计分析。
结果 ①在KD急性期，CAL+组DeRitis比值等结果显著高于CAL-组（DeRitis比值：1.74±0.68 vs. 1.16±0.32 vs. 0.76±0.24，F=26.858，P＜0.001），且CAL+ 8周持续扩张组的患儿DeRitis比值亦高于CAL+ 8周内恢复组（1.74±0.68 vs. 1.16±0.32，t=3.376，P=0.002），差异均有统计学意义；②经IVIG等治疗8周后观察CAL+组的KD患儿， CAL+ 8周持续扩张组的KD患儿DeRitis比值显著高于CAL+ 8周内恢复组，差异有统计学意义（1.86±0.42 vs. 1.23±0.36，t=4.871，P＜0.001）。
结论 DeRitis比值等可作为典型KD急性期预测CAL发生的较为敏感的检测指标，亦在评估合并CAL的KD患儿短期预后中有一定的预警作用。


关键词: 黏膜皮肤淋巴结综合征, 冠状动脉, DeRitis比值

Abstract: Objective To evaluate the significance of DeRitis ratio and other biochemical markers in evaluating coronary artery lesions (CAL) in children with typical Kawasaki disease (KD). 
Methods A total of 96 children with KD who were treated at Hebei Children′s Hospital from June 2022 to June 2024 were enrolled. Based on echocardiographic findings, patients were divided into two groups: the CAL+ group (with CAL complications, n=35) and the CAL- group (without CAL complications, n=61). The CAL+ group was further subdivided into patients whose coronary arteries recovered within 8 weeks of treatment (n=23) and those with persistent coronary artery dilation after 8 weeks (n=12). Peripheral venous blood samples were collected under fasting conditions during the acute phase of KD, clinical recovery phase, and at 8 weeks after intravenous immunoglobulin (IVIG) treatment. Liver function, myocardial enzyme profiles, and serum electrolytes were measured, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), lactate dehydrogenase (LDH), and serum sodium levels. DeRitis ratio and LDH/AST ratio were calculated, and statistical analyses were performed. 
Results ①During the acute phase of KD, the CAL+ group showed significantly higher DeRitis ratio compared with the CAL- group (1.74±0.68 vs. 1.16±0.32 vs. 0.76±0.24, F=26.858, P＜0.001). Furthermore, the DeRitis ratio in the CAL+ persistent dilation subgroup was higher than that in the CAL+ recovery subgroup (1.74±0.68 vs. 1.16±0.32, t=3.376, P=0.002), with both differences being statistically significant. ② At 8 weeks after IVIG treatment, the CAL+ persistent dilation subgroup exhibited a significantly higher DeRitis ratio compared with the CAL+ recovery subgroup (1.86±0.42 vs. 1.23±0.36, t=4.871, P＜0.001), indicating a significant difference. 
Conclusion The DeRitis ratio and related biochemical markers are sensitive indicators for predicting the occurrence of CAL during the acute phase of typical KD. They also provide early prognostic insights into short-term outcomes in KD patients with CAL. 


Key words: mucocutaneous lymph node syndrome, coronary artery, DeRitis ratio

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