川崎病合并冠状动脉损害的危险因素分析  

Analysis of Risk Factors of Kawasaki Disease with Coronary Artery Lesion

作　　者：左梦颖 孙凌[1] 吕海涛[1] 严文华[1] 王波[1] 曹磊[1] 陈烨[1] 侯淼[1] ZUO Meng-ying;SUN Ling;LVHai-tao;YAN Wen-hua;WANG Bo;CAO Lei;CHEN Ye;HOU Miao(Children's Hospital of Soochow University,Suzhou,Jiangsu,215003,China)

机构地区：[1]苏州大学附属儿童医院,江苏苏州215003

出　　处：《中国血液流变学杂志》2019年第3期285-289,共5页Chinese Journal of Hemorheology

摘　　要：目的探讨儿童川崎病初始丙种球蛋白(IVIG)治疗前的临床表现、体征及相关实验室指标对冠状动脉损害(CAL)的预测意义.方法回顾性分析180例川崎病患儿临床资料,根据急性期超声心动图结果分为冠状动脉损害组(CAL组)58例及无冠状动脉损害组(nCAL组)122例,收集两组患儿初始IVIG治疗前的相关资料,包括年龄、性别、治疗前热程、口唇改变、结膜充血、淋巴结肿大、手足硬肿、肛周潮红脱屑、皮疹、卡疤改变、川崎病分型(完全型川崎病/不完全型川崎病)等情况,并检测两组治疗前白细胞计数(WBC)、血红蛋白(Hb)、血小板计数(Plt)、中性粒细胞百分比(N%)、嗜酸性粒细胞百分比(E%)、C反应蛋白(CRP)、血沉(ESR)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、乳酸脱氢酶(LDH)、中性粒细胞绝对值与淋巴细胞绝对值比值(NLR)、血小板与淋巴细胞绝对值比值(PLR)、血清钠、CD4/CD8、IgA、IgM、IgG、纤维蛋白原(Fib)、D-二聚体、补体C3及补体C4等指标,对两组资料进行单因素分析,根据单因素分析结果,选取可能的危险因素,进行Logistic回归分析.结果(1)CAL组出现口唇改变概率高于nCAL组,差异具有统计学意义(P<0.05).(2)CAL组初始IVIG治疗前ALB、补体C3、Hb、Fib水平均低于nCAL组,LDH水平高于nCAL组,差异具有统计学意义(P<0.05).(3)Logistic回归分析显示,初始IVIG治疗前补体C3降低、LDH升高是川崎病合并CAL的独立危险因素(P<0.05).结论早期检测并动态追踪血清补体C3、LDH的浓度水平,可在病程早期预测川崎病合并CAL,为临床及时治疗、减少CAL提供依据,并指导临床后期重点随访CAL情况.Objective To investigate the predictive significance of clinical manifestations,signs and relevant laboratory indicators for coronary artery lesions(CAL)in children with Kawasaki disease before intravenous immune globulin(IVIG)treatment.Methods This retrospective study included a cohort of 180 children with Kawasaki disease.They were divided into CAL group(CAL caused by Kawasaki disease,n=58)and nCAL group(Kawasaki disease only,n=122)according to the results of echocardiography.The patients'clinical data and laboratory indicators were collected,including age,gender,fever time before IVIG,oral change,conjunctival congestion,cervical lymphadenopathy,edema of the hands and feet,crissum flush desquamation,rush,erythema and induration at BCG inoculation site,Kawasaki disease classification(completely Kawasaki disease/incomplete Kawasaki disease),white blood cell count(WBC),hemoglobin(Hb),platelet count(Pit),neutrophil percentage(N%),eosinophils percentage(E%),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),aspartate aminotransferase(AST),albumin(ALB),lactate dehydrogenase(LDH),lymphocyte absolute value of absolute value of neutrophils ratio(NLR),platelet and the lymphocyte absolute value ratio(PLR),serum sodium,CD4/CD8,IgA,IgM and IgG,fibrinogen(Fib),D-dimer,complement C3,complement C4,the univariate analysis was performed on these data,then multivariate Logistic regression analysis was used to determine independent risk factors.Results(l)The probability of oral changes in CAL group was higher than that in nCAL group(P<0.05).(2)ALB,C3,Hb and Fib levels before IVIG in CAL group were lower than those in nCAL group,and LDH level in CAL group was higher than that in nCAL group(P<0.05).(3)Logistic regression analysis showed that decreased complement C3 level and increased LDH level before treatment were independent risk factors of CAL caused by Kawasaki disease(P<0.05).Conclusion Early detection and dynamic tracking of serum complement C3 and LDH level can predict CAL,offer evidence for the timely treatment,red

关 键 词：川崎病 冠脉损害 危险因素 

分 类 号：R725.4[医药卫生—儿科]