川崎病并发冠状动脉瘤高危因素分析  

Risk factors for coronary artery aneurysms in children with Kawasaki disease

作　　者：陈尊[1] 钱颖[1] 施忆玫 王有成[1] 蒋国平[2] 

机构地区：[1]金华市人民医院儿科,浙江省金华321000 [2]浙江大学医学院附属儿童医院超声科,杭州310003

出　　处：《中国医师杂志》2016年第9期1340-1344,共5页Journal of Chinese Physician

摘　　要：目的探讨小儿川崎病（KD）并发冠状动脉瘤（CAA）的高危因素，以便早期预测冠状动脉损害发生的可能性，尽早采取干预措施，及时治疗和随访，避免严重心血管疾病后遗症的发生。方法收集2009年1月至2014年1月在浙江大学医学院附属儿童医院确诊为KD的患儿共679例，其中并发CAA的患儿42例（KD并发CAA组），并发冠状动脉扩张（CAD）的患儿181例（KD并发CAD组），未并发任何冠脉损害的患儿456例[冠脉正常（NCAL）组]。对与冠状动脉损害发生有关的因素如性别、年龄、发热时间、白细胞计数（WBC）、血红蛋白（Hb）、血小板计数（PLT）、红细胞沉降率（ESR）、C反应蛋白（CRP）、谷丙转氨酶、血清钾、血浆氨基末端脑利钠肽前体（NT-proBNP）、丙球耐药，采用SPSS 18.0软件包进行统计分析，先对CAA组的高危因素行单因素分析，对有统计学意义的指标再行Logistic多元回归分析。结果单因素分析采用χ2检验，结果显示男性、发热时间〉14 d、NT-proBNP≥1 000 ng/L、丙球耐药与KD并发CAA有关（P〈0.05），进一步行Logistic多因素分析结果显示男性[OR＝4.092，95% CI（1.514，11.060），P＝0.004]、发热时间〉14 d[OR＝12.436，95% CI（4.599，33.631），P＝0.000]、NT-proBNP≥1 000 ng/L[OR＝3.305，95% CI（1.401，7.794），P＝0.005]、丙球耐药[OR＝3.842，95% CI（1.562，9.453），P＝0.000]四者均为KD并发CAA的独立危险因素。结论男性患儿、发热时间〉14 d、NT-proBNP≥1 000 ng/L、丙球耐药是KD并发CAA的高危因素。ObjectiveTo explore risk factors for coronary artery aneurysms （CAA） in children with Kawasaki disease （KD）, and reduce the rate of serious sequelae of cardiovascular diseases. MethodsAll the patients were diagnosed as KD in Children＇s Hospital Affiliated to Medical College of Zhejiang University from January 2009 to January 2014. A total of 679 cases was included, and 42 with concurrent CAA, 181 with concurrent coronary artery expansion （CAD）, and 456 without coronary artery damage cases （non-coronary artery lesion, NCAL）. Coronary artery damage was related to factors such as gender, age, fever, white blood cell count （WBC）, hemoglobin （Hb）, platelet count （PLT）, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, alanine aminotransferase, serum potassium, plasma amino terminal brain natriuretic peptide precursor （NT-proBNP）, and acrylic ball resistance. SPSS 18.0 software package was used for risk factor analysis. Qualitative data using chi-square test, was used to analyze the high risk factors of CAA group, and logistic multivariate regression analysis was also used. ResultsChi-square test showed that male, with febrile days 〉14 d, NT-proBNP ≥ 1 000 ng/L, immunoglobulin resistance was more likely to have KD concurrent CAA （P〈0.05）. Multiple Logistic regression analysis showed that male [OR=4.092, 95% CI （1.514, 11.060）, P=0.004], febrile days 〉14 d [OR=12.436, 95% CI （4.599, 33.631）, P=0.000], NT-proBNP≥1 000 ng/L [OR=3.305, 95% CI （1.401, 7.794）, P=0.005], and immunoglobulin resistance [OR=3.842, 95% CI （1.562, 9.453）, P=0.000] were independent risk factors for KD concurrent CAA. ConclusionsMale children, febrile days 〉14 d, NT-proBNP≥1 000 ng/L, and immunoglobulin resistance were independent risk factors of CAA.

关 键 词：黏膜皮肤淋巴结综合征/并发症 冠状动脉瘤/并发症 危险因素 

分 类 号：R725.4[医药卫生—儿科]