再发川崎病的临床特点及相关危险因素分析  

Clinical characteristics and risk factors of recurrent Kawasaki disease

作　　者：吴佳慧 成芳芳[1] 孔小行[1] 吕海涛[2] WU Jiahui;CHENG Fangfang;KONG Xiaoxing;LYU Haitao(Department of Infectious Diseases,Suzhou 215003,Jiangsu,China;Department of Cardiology,Children’s Hospital of Soochow University,Suzhou 215003,Jiangsu,China)

机构地区：[1]苏州大学附属儿童医院感染科,江苏苏州215003 [2]苏州大学附属儿童医院心内科,江苏苏州215003

出　　处：《临床儿科杂志》2020年第7期485-489,共5页Journal of Clinical Pediatrics

基　　金：国家自然科学基金(No.81570455);江苏省自然科学基金(No.BE2017660)。

摘　　要：目的探讨川崎病(KD)再发的临床特点及相关危险因素。方法回顾分析2010-2018年间收治的再发性KD患儿的临床特点及危险因素。结果研究期间共收治2 112例初发KD患儿,其中35例再发,再发率1.66%。35例再发KD患儿首次发病后KD再发的中位时间为13.5(4~69)月。与初发患儿相比,再发患儿的发热时间缩短,四肢硬肿比例较低,C反应蛋白升高,血清钾降低,差异均有统计学意义(P<0.05)。35例再发KD患儿中,11例初发时有冠状动脉病变(CAL),8例在再发时亦出现CAL。Logistic回归分析显示,支原体感染和CD19^+CD23^+淋巴细胞亚群比例升高是KD再发的独立危险因素(P<0.05)。以再发风险评分绘制ROC曲线,曲线下面积为0.84(95%CI:0.76~0.91),最佳临界值为1.24时,其敏感性和特异性分别为0.83和0.70。结论 KD发生后至少应随访2年,支原体感染和CD19^+CD23^+淋巴细胞亚群升高可作为KD再发的预测指标。初发KD发生CAL者再发时更易发生CAL。Objective To explore the clinical characteristics and risk factors of recurrent Kawasaki disease(KD).Method The clinical characteristics and risk factors of recurrent KD in children admitted between 2010 and 2018 were retrospective analyzed.Results A total of 2112 children with primary KD were admitted during the study period,35 of whom were recurrent and a recurrence rate of 1.66%.The median time of KD recurrence in 35 children was 13.5 (4~69) months after the first onset of KD.Compared with the children with initial onset,the fever duration in the children with recurrent onset was shorter,the proportion of edema in extremities was lower,the C-reactive protein was increased,and the serum potassium was decreased,and the differences were statistically significant (all P<0.05).Among 35 children with recurrent KD,11 had coronary artery lesion (CAL) at the initial stage,8 of whom had CAL again at the time of recurrence.Multivariate logistic regression analysis showed that Mycoplasma pneumoniae infection and the increased proportion of CD19+CD23+ lymphocyte subsets were independent risk factors for KD recurrence (both P<0.05).The ROC curve was drawn based on the recurrence risk score.The area under the curve was 0.84 (95%CI:0.76~0.91).When the best critical value was 1.24,the sensitivity and specificity were 0.83 and 0.70,respectively.Conclusions KD children should be followed up for at least 2 years after onset.Mycoplasma pneumoniae infection and elevated CD19+ CD23+ lymphocyte subsets can be used as predictors of KD recurrence.Children who had CAL at the initial onset of KD are also more likely to have CAL at the recurrence of KD.

关 键 词：川崎病 再发 危险因素 冠状动脉损害 

分 类 号：R725.4[医药卫生—儿科]