川崎病并发冠状动脉损伤的危险因素及预测因子研究  

Risk factors and predictors of coronary artery lesion in children with Kawasaki disease

作　　者：胡红梅 邱云 谢帅 尹显蓉 赵艳 尹凤 王凡 李龙燕 Hu Hongmei;Qiu Yun;Xie Shuai;Yin Xianrong;Zhao Yan;Yin Feng;Wang Fan;Li Longyan(Department of Pediatrics,Mianyang Hospital,School of Medicine,University of Electronic Science and Technology of China/Mianyang Central Hospital,Mianyang Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院/绵阳市中心医院儿科,四川绵阳621000

出　　处：《保健医学研究与实践》2023年第8期71-75,共5页Health Medicine Research and Practice

基　　金：四川省基层卫生事业发展研究中心资助项目(SWFZ21-Z-08);四川医院管理和发展研究中心资助项目(SCYG2022-20)。

摘　　要：目的探讨川崎病(KD)患儿并发冠状动脉损伤(CAL)的危险因素及预测因子。方法收集电子科技大学医学院附属绵阳医院2018年2月—2022年2月收治的197例KD患儿的临床资料,根据超声造影检查中冠状动脉病变情况分为CAL组(68例)及无CAL组(129例)。了解患儿CAL发生情况,采用多因素条件Logistic回归模型分析KD患儿并发CAL的危险因素,并绘制受试者工作特征(ROC)曲线分析相关因子对KD患儿并发CAL的预测价值。结果CAL组患儿血小板计数(PLT)、基质金属蛋白酶1(MMP-1)、循环内皮细胞(CEC)水平均高于无CAL组,微小核糖核酸-145(miR-145)表达水平低于无CAL组,年龄<3岁、治疗前发热天数≥10 d、12导联心电图(EKG)异常比例明显高于无CAL组,差异均有统计学意义(P<0.05);2组患儿白细胞计数(WBC)、C反应蛋白(CRP)水平、性别构成、静脉注射免疫球蛋白(IVIG)治疗情况比较,差异均无统计学意义(P>0.05)。多因素条件Logistic回归分析结果显示,PLT≥500×10^(9)/L(OR=1.680,95%CI:1.001~2.819)、MMP-1≥15.33 ng/m L(OR=1.845,95%CI:1.049~3.246)、CEC≥2.16×10^(9)/L(OR=1.538,95%CI:1.183~2.001)、miR-145<1.03(OR=1.371,95%CI:1.127~1.668)、年龄<3岁(OR=1.630,95%CI:1.074~2.475)、治疗前发热天数≥10 d(OR=1.747,95%CI:1.430~2.133)、EKG异常(OR=1.596,95%CI:1.045~2.438)为KD患儿并发CAL的危险因素(P<0.05)。ROC分析结果显示,PLT、MMP-1、CEC、miR-145、年龄、治疗前发热天数、EKG预测KD患儿并发CAL的ROC曲线下面积(ACU)分别为0.786、0.783、0.848、0.765、0.845、0.920及0.936。结论KD患儿并发CAL的危险因素较多,PLT≥500×10^(9)/L、MMP-1≥15.33 ng/mL、CEC≥2.16×10^(9)/L、miR-145<1.03、年龄<3岁、治疗前发热天数≥10 d、EKG异常可作为临床预测KD患儿并发CAL的有效指标,在临床中可通过监测患儿上述因子变化情况为临床干预提供参考依据。Objective This paper aims to investigate the risk factors and predictive factors of coronary artery lesion(CAL)in children with Kawasaki disease(KD).Methods The clinical data of 197 children with KD admitted to the Mianyang Hospital affiliated to the School of Medicine,University of Electronic Science and Technology of China from February 2018 to February 2022 were collected as participants,They were assigned to the CAL group(n=68)and no CAL-free group(n=129)according to coronary lesious during contrast-enhanced ultrasonography.To understand the occurrence of CAL in children,the multivariate conditional logistic regression model was used to analyze the risk factors of CAL in children with KD,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of related factors for CAL in children with KD.Results The levels of platelet count(PLT),matrix metalloproteinase-1(MMP-1)and circulating endothelial cells(CEC)in CAL group were higher than those in non-CAL group,the expression level of micronuclein-145(miR-145)was lower than that in non-CAL group,the age<3 years,the days of fever before treatment≥10 d,and the abnormal proportion of 12-lead electrocardiogram(EKG)were higher than those in non-CAL group,all with statistical significance(P<0.05).No significant differences were observed in the white blood cell count(WBC),C-reactive protein(CRP)level,gender composition,and intravenous immunoglobulin(IVIG)treatment between the two groups(P>0.05).The results of multivariate conditional logistic regression analysis showed that PLT≥500×10^(9)/L(OR=1.680,95%CI:1.001-2.819),MMP-1≥15.33 ng/mL(OR=1.845,95%CI:1.049-3.246),CEC≥2.16×10^(9)/L(OR=1.538,95%CI:1.183-2.001),miR-145<1.03(OR=1.371,95%CI:1.127-1.668),age<3 years(OR=1.630,95%CI:1.074-2.475),fever days≥10 days before treatment(OR=1.747,95%CI:1.430-2.133),and abnormal EKG(OR=1.596,95%CI:1.045-2.438)were risk factors for CAL in children with KD(P<0.05).The results of ROC analysis showed that PLT,MMP-1,CEC,miR-145,age,days of fever b

关 键 词：川崎病 冠状动脉损伤 预测因子 基质金属白酶-1 循环内皮细胞 微小核糖核酸-145 

分 类 号：R725.4[医药卫生—儿科]