分析超声心动图诊断川崎病冠状动脉Ⅱ、Ⅲ、Ⅳ级损害的相关因素  

Related factors for coronary artery damage of level Ⅱ,Ⅲ and Ⅳ in Kawasaki disease evaluated by echocardiography

作　　者：王婧[1] 张春霞[1] 雪梅[1] 张丹[1] 胡燕华[1] 张小杉[1] 

机构地区：[1]内蒙古医科大学附属医院,内蒙古呼和浩特010050

出　　处：《中国临床医学影像杂志》2016年第12期871-874,880,共5页Journal of China Clinic Medical Imaging

摘　　要：目的：分析超声心动图诊断川崎病（KD）冠状动脉损害（CAL）临床Ⅱ、Ⅲ、Ⅳ级损害的相关因素。方法：收集我院近5年的KD患儿416例为研究对象。经超声心动图检查发现，Ⅱ、Ⅲ、Ⅳ级损害179例，为病例组，未损害的237例为对照组。对两组的年龄、性别和血小板计数等44项可能为Ⅱ、Ⅲ、Ⅳ级损害的相关因素予以收集记录。资料在单因素分析的基础上又进行多因素logistic回归分析。结果：热程每增加1d、血小板计数每增加1×10^9L^-1、血沉每增加lmm／h、C反应蛋白每增加1μg/L和N末端脑钠肽前体每增加1ng／L，促进Ⅱ、Ⅲ、Ⅳ级损害的危险分别是原来的1．254、2．813、1．073、3．845和1．083倍（均OR〉I,其95％可信区间内均不包含1，均P〈0.05），促进患病；男性Ⅱ、Ⅲ、Ⅳ级损害的危险是女性的12．276倍（OR〉1，其95％可信区间内不包含1，P〈0．05），亦促进患病；而应用丙种球蛋白（IVIG）及其应用初始时间为5～〈10d。促进Ⅱ、Ⅲ、Ⅳ级损害的危险分别是不应用IVIG和应用其初始时间为〈5d或≥10d的0．412及0．115倍（均OR〈1，其95％可信区间内均不包含1，均P〈0．05）。阻止患病。结论：增加热程、血小板计数、血沉、C反应蛋白和N末端脑钠肽前体及男性为Ⅱ、Ⅲ、Ⅳ级损害的危险因素；而应用IVIG和应用初始时间5～9d为其保护因素。Objective： To analyze the related factors for coronary artery lesions （CAL） of level Ⅱ,Ⅲ and Ⅳ in Kawasaki disease （KD） diagnosed by echocardiography. Methods： We collected 416 children with KD as the research object in the past five years. We found 179 cases of level U, Ili and IV damage by echocardiography, defined as the case group, and 237 cases without damage, defined as the control group. We collected 44 clinical items such as age, gender and platelet count, which may be the related factors for artery damage of level Ⅱ,Ⅲ and Ⅳ in two groups. Data were analyzed by single factor analysis and multivariable logistic regression. Results： Increase of thermal process by 1 day, increase of platelet by 1×10^9L^-1, increase of blood sedimentation by 1 mm/h, increase of c-reactive protein by 1 μg/L and increase of N terminal brain natriuretic peptide precursor by 1 ng/L increased the risk of level Ⅱ,Ⅲ and Ⅳ damage by 1,254, 2.813, 1.073, 3.845 and 1.083 times, respectively, compared with the control （OR〉1, the 95% confidence interval did not contain 1, P〈0.05）, and accelerated the course of the disease. The risk of level lI, m and IV damage （OR〉l, the 95% confidence interval did not contain 1, P〈 0.05） was 12.276 times higher in male than female, and also promoted the disease. IVIG and its initial time of 5～〈10 days decreased the risk of level Ⅱ,Ⅲ and Ⅳ damage by 0.412 and 0.115 times, respectively, compared with those who were not given IVIG or with initial time 〈5 days or ≥ 10 days, （OR〈1, the 95% confidence interval did not contain 1, P〈0.05）. Conclusion： Increasing of thermal process, platelet, blood sedimentation, C-reactive protein, N terminal brain natriuretic peptide precursor and male are risk factors for level Ⅱ,Ⅲ and Ⅳ damage. And IVIG with initial time of 5-9 days are its protective factors.

关 键 词：粘膜皮肤淋巴结综合征 创伤和损伤 冠状动脉 超声心动描记术 

分 类 号：R725.4[医药卫生—儿科] R540.45[医药卫生—临床医学]