摘要目的: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内患儿疗效，将其分为IVIG敏感组和IVIG无反应组。比较2组患儿的一般临床资料，接受初始IVIG治疗前的HRV、DC、血常规、肝功能、肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)和红细胞沉降率(ESR)。采用多因素 Logistic回归分析影响IVIG无反应KD的危险因素。 结果:679例KD患儿中失访3例，余676例中IVIG敏感586例，IVIG无反应90例。IVIG敏感组及IVIG无反应组的HRV指标及DC均低于健康对照组，3组间比较差异均有统计学意义(均 P<0.05)。IVIG无反应组的正常窦性N-N间期标准差(SDNN)[(65.84±38.22) ms比(82.56±21.41) ms， P＝0.004]、低频功率(LF)[(192.59±114.10) ms 2比(258.18±162.75) ms 2， P＝0.048]均低于IVIG敏感组。IVIG敏感组及IVIG无反应组的白细胞(WBC)、血小板(PLT)、hs-CRP、ESR、丙氨酸转氨酶(ALT)、cTnI及NT-proBNP均高于健康对照组，3组间比较差异有统计学意义(均 P<0.05)。其中，IVIG无反应组的ESR[(90.32±37.91) mm/1 h比(65.81±25.34) mm/1 h， P＝0.019]、cTnI[(0.83±0.35) μg/L比(0.52±0.18) μg/L， P＝0.037]及NT-proBNP[(854.64±293.02) ng/L比(584.95±177.11) ng/L， P＝0.011]均高于IVIG敏感组。多因素 Logistic回归分析显示，SDNN( OR＝0.783，95% CI：0.341～0.979， P＝0.021)、NT-proBNP( OR＝1.195，95% CI：1.061～1.428， P＝0.034)是预测IVIG无反应KD的独立危险因素。 结论:SDNN、NT-proBNP可能是IVIG无反应KD的独立预测因素。

abstractsObjective: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) ms 2vs. (258.18±162.75) ms 2, 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.