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Objective To assess the neutrophil-to-lymphocyte ratio (NLR) to predict coronary artery dilation in patients with Kawasaki disease (KD).Methods The blood routine were collected from all patients with KD before intravenous immunoglobulin(IVIG) treatment and after 2 days of IVIG treatment.NLR was calculated through dividing the neutrophil count by the lymphocyte.Multivariate Logistic analysis and receiver-operating characteristic (ROC) curve were used to determine the value of NLR predicting coronary artery dilation and the risk factors of coronary artery dilation in KD.Results Of the 404 cases with KD,50 cases were coronary artery dilation.Compared with the patients without coronary artery dilatation,patients with coronary artery dilatation were more inclined to occur in males (76.0％ vs.51.7％,x2 =10.45,P ＜0.01) at younger ages[(26.5 ±7.1) months vs.(31.3 ±8.4) months,t =3.85,P ＜ 0.01],while the days of fever pre-IVIG treatment [(6.9 ± 1.6) d vs.(5.5 ± 1.2) d,t =7.38,P ＜ 0.01] and after IVIG treatment [(4.7 ± 1.3) d vs.(2.1 ± 0.9) d,t =17.97,P ＜ 0.01] as well as total fever days [(10.2 ± 3.7) d vs.(7.5 ± 2.5) d,t =6.68,P ＜ 0.01] were all longer.Meanwhile,before IVIG treatment,patients with coronary artery dilatation had higher leukocytes [(18.6 ± 5.2) × 109/L vs.(15.4 ± 4.4) × 109/L,t =4.70,P ＜0.01],NLR value (4.5 ±0.8 vs.3.1 ± 0.4,t =19.82,P ＜0.01),neutrophil [(13.7 ±6.3) × 109/L vs.(10.2 ± 4.3) × 109/L,t =5.05,P＜0.01] and C-reactive protein(CRP) [(108.4 ±26.9) mg/Lvs.(99.5 ±32.3) mg/L,t =1.86,P ＜ 0.05],and the differences were statistically significant.However,between coronary artery dilatation group and non-coronary artery dilatation group,the lymphocyte number,platelet and erythrocyte sedimentation rate were not significantly different before IVIG treatment (all P ＞ 0.05).And the WBC [(10.4 ± 5.2) × 109/L vs.(8.3 ± 4.6) × 109/L,t=3.04,P＜0.01],NLR value (2.1 ±0.7 vs.1.2 ±0.5,t =13.87,P ＜0.01),nentrophil [(8.2 ± 1.7) × 109/L vs.(5.3 ± 1.2) × 109/L,t =16.37,P ＜0.01],platelet (PLT) [(492.4 ± 68.3) × 109/L vs.(445.6 ± 82.4) ×109/L,t=3.84,P＜0.01],CRP [(46.2±28.8) mg/L vs.(19.5±10.8) mg/L,t=12.47,P＜0.01],ESR[(45.9 ±28.6) mm/1 h vs.(28.2 ± 15.7) mm/1 h,t =6.63,P ＜0.01] of patients with coronary artery dilatation after IVIG treatment were also higher than the patients without coronary artery dilatation,and all of the differences were statistically significant.The ROC curve result revealed that the best NLR cut-off value during the acute febrile phase for predicting coronary artery dilation was 4.51,and the area under the curve was 0.82 (95％ CI 0.75-0.89) with sensitivity and specificity of 0.78 and 0.80,respectively.At the same time the best NLR cut-off values in 2 days after IVIG for predicting coronary artery dilation was 1.46,and the area under the curve was 0.85 (95％ CI 0.79-0.92) with sensitivity and specificity of 0.84 and 0.79,respectively.Multivariate Logistic analysis revealed that the days of fever before and after IVIG treatment,total fever days,NLR before and after IVIG treatment,as well as WBC and CRP after treatment with IVIG were all independent predictive factors of coronary artery dilation development.Conclusion The NLR could be used to predict coronary artery dilation development in patients with KD.
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BACKGROUND: To tonify qi, benefit spleen and primary qi, strengthen tendons and bones and promote circulations in meridians and collaterals are the classical principles in Chinese medicine for anti-kinetic fatigue.OBJECTIVE: To observe the efficacy of compound Chinese herbal medicine on anti-kinetic fatigue.DESIGN: Randomized controlled experiment based on animals.SETTINGS: Animal Experimental Center of Wenzhou Normal University and Zhejiang College of Traditional Chinese Medicine.MATERIALS: The experiment was performed in Animal Experimental Center of Zhejiang College of Traditional Chinese Medicine from February to June 2001, in which, 80 ICR mice of either sex, body weighted(22±2) g and 40 SD male rats, body weighted(194±7) g were employed.ETHODS: ① Eighty mice were randomized into two groups, of which, 40 mice was gastric-infused with Chinese herbal fiang li fang(experimental group) and 40 mice was with physiological saline (the control) . After bred for 15 days, they were randomized into 3 groups for anti-fatigue experiment ( n = 15, swimming time), anti-hypoxia ability( n = 15) and determination of hemoglobin(n=10). ② Determination of testosterone: Forty rats were randomized into 4 groups, named the control with physiological saline infusion, herbal infusion group, exercise group, exercise-herbal infusion group. In herbal infusion group, the rats were infused once a day. In exercise group and exercise-herbal infusion group, the rats exercised once a day, swimming till being exhausted at the tolerance of 3% body weight at 28 ℃ of water temperature. After bred for 20 days, heart blood 2 mL was collected with chest opened and the serum was centrifuged and placed in refrigerator at 4 ℃. Minigamma 1275γ counter and VCS method were applied for determina tion.MAIN OUTCOME MEASURES: ① Determination of swimming time of mice in every group. ③ Time of anti-hypoxia. ③ Levels of hemoglobin and testosterone in rats.RESULTS: Forty rats and 80 mice were all entered the result analysis. ①Observation of swimming time in mice: The time was remarkably prolonged in experimental group compared with the control[ (125.2±13.7), (108.9 ±12.6) minutes, P＜0.01] . ② Anti-hypoxia ability: It was much improved in experimental group compared with the control[(25.0±l.5),(23.1 ±1.8) minutes, P ＜0.05] . ③ Level of hemoglobin: The level of hemoglobin in experimental group was higher than that in the control, but the difference was not significant[(162.1 ±5.2), (159.3 ±5.3) g/L] . ④Level of testosterone: That in exercise group of rats was remarkably lower than exercise-herbal infusion group[(4.69 ±0.92), (6.03 ±0.77) nmol/L,P ＜ 0.05 ] . The difference in testosterone level was not significant between the control with infusion of physiological saline and herbal infusion group [(6.59 ±0.91), (6.98 ±0. 88) nmol/L, P ＞ 0.05].CONCLUSION: Under fatigue state, fian lifang can prolong the time of swimming in mice, improve work time and efficacy, increase hemoglobin content and benefit anti-hypoxia ability, which indicates rather strong anti-fatigue action. The combination of Chinese herbal jian lifang and exercise training can much' significantly increase serum testosterone level in rats compared with exercise group, which explains that fian li fang can increase testosterone level in rats, prevent testosterone decrease induced by exhausted exercise and accelerate the recovery of physical function.