川崎病冠状动脉损害相关危险因素分析  

Analysis of risk factors of coronary artery damage in Kawasaki disease

作　　者：王复娟 吴良霞[1] WANG Fujuan;WU Liangxia(Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院,上海200233

出　　处：《临床儿科杂志》2020年第7期481-484,共4页Journal of Clinical Pediatrics

基　　金：上海市卫生计生系统重要薄弱学科建设基金(No.2016ZB0102-03)。

摘　　要：目的探讨川崎病(KD)并发冠状动脉损害(CAL)的相关危险因素。方法回顾性分析110例KD患儿的临床资料,根据超声心动图检查结果分为冠脉损害组(CAL组)40例,无冠脉损害组(NCAL组)70例,进行统计分析。结果110例KD患儿的中位发病年龄为1.58(0.92~3.00)岁,其中男67例、女43例。CAL组和NCAL组间年龄分布、不典型KD、静脉用丙种球蛋白(IVIG)前发热持续时间>6天比例差异均有统计学意义(P<0.05)。CAL组患儿C反应蛋白(CRP)、白细胞(WBC)、白介素-6(IL-6)、N端脑钠肽前体(NT-proBNP)水平均明显高于NCAL组,差异均有统计学意义(P<0.05)。IVIG使用前发热持续时间、WBC、IL-6、NT-proBNP预测KD患儿并发CAL的受试者工作特征曲线(ROC)下面积(AUC)分别为0.97、0.69、0.76和0.87;最佳临界值分别为6.5天、19.85×10~9/L、92.19 pg/mL和1122.5 pg/mL,预测KD并发CAL的灵敏度分别为84.6%、46.2%、100%和100%,特异度分别为91.4%、91.4%、57.1%和71.4%。结论年龄<3岁,IVIG前发热持续时间>6.5天,不典型KD,以及WBC、IL-6和NT-proBNP明显升高,是KD发生CAL的危险因素。Objective To explore the risk factors of coronary artery lesion (CAL) in Kawasaki disease (KD).Methods The clinical data of KD in 110 children were analyzed retrospectively.According to the results of color Doppler echocardiography,they were divided into two groups:coronary injury group (CAL group,40 cases) and non-coronary injury group (NCAL group,70 cases).Results The median age at KD onset in 110 children (67 males and 43 females) was 1.58 years old (0.92~3.00 years).There were significant differences in the age distribution and the proportions of atypical KD and fever duration> 6 days before intravenous IVIG between CAL group and NCAL group,and the difference were statistically significant (both P<0.05).The levels of C-reactive protein (CRP),interleukin-6 (IL-6),N-terminal brain natriuretic peptide precursor (NT-proBNP) and white blood cells count (WBC) in the CAL group were significantly higher than those in the NCAL group (all P<0.05).The area under ROC curve (AUC) predicted by the duration of fever before IVIG,WBC,IL-6,and pro-BNP was 0.97,0.69,0.76,and 0.87 respectively in CAL group.The optimal thresholds were 6.5 days,19.85×10~9/L,92.19 pg/mL,and 1122.5 pg/mL respectively.The sensitivity of predicting CAL in KD was 84.6%,46.2%,100%,and 100%,and the specificity was 91.4%,91.4%,57.1%,and 71.4% respectively.Conclusion Age<3 years,fever duration before IVIG > 6.5 days,atypical KD,and significantly increased WBC,IL-6,and NT proBNP were risk factors for the occurrence of CAL in KD.

关 键 词：川崎病 冠状动脉损害 危险因素 儿童 

分 类 号：R725.4[医药卫生—儿科]