儿童川崎病并发冠状动脉损害的危险因素分析

Risk factors for coronary artery lesions secondary to Kawasaki disease in children

摘要:

目的 探讨儿童川崎病(KD)并发冠状动脉损害(CAL)的危险因素。方法 回顾性分析895例KD患儿的病历资料,将其分为并发CAL 组(n=284)和未并发CAL 的对照组(n=611),比较两组临床及实验室指标,并对KD 患儿并发CAL的危险因素进行多因素logistic 回归分析。结果 男性、发生CAL 以外并发症、不典型KD、静脉注射丙种球蛋白(IVIG)抵抗、IVIG 治疗前发热时间>5 d、血清降钙素原(PCT)增高为KD患儿并发CAL 的独立危险因素(OR 值分别为1.712、2.028、3.655、2.912、1.350、1.068,均P<0.05),而血清白蛋白(ALB)较高为保护性因素(OR=0.931,P<0.05)。血清PCT 与ALB 预测KD 患儿并发CAL的曲线下面积(AUC)分别为0.631、0.558。结论 男性KD患儿、不典型KD 患儿以及发生CAL 以外并发症、发热时间较长、IVIG 治疗抵抗的KD患儿并发CAL 的风险较高。血清PCT与ALB预测KD患儿并发CAL的价值不大。

Abstract:

Objective To explore the risk factors for coronary artery lesions (CAL) secondary to Kawasaki disease (KD) in children.Methods The medical data of 895 children with KD were retrospectively reviewed. The patients were classified into two groups according to the presence of CAL:CAL (n=284) and control (n=611). The clinical and laboratory indices were compared between the two groups.The risk factors for the development of CAL in children with KD were identified by multiple logistic regression analysis.Results Male gender (OR=1.712), occurrence of non-CAL complications (OR=2.028), atypical KD (OR=3.655), intravenous immunoglobulin (IVIG) resistance (OR=2.912), more than 5 days of fever duration before IVIG treatment (OR=1.350), and increased serum procalcitonin (PCT) level (OR=1.068) were the independent risk factors for the development of CAL in children with KD (P<0.05), whereas increased serum albumin (Alb) level was a protective factor (OR=0.931, P<0.05). The areas under the receiver operating characteristic curve of serum PCT and ALB for prediction of the development of CAL in children with KD were 0.631 and 0.558, respectively.Conclusions Male gender, atypical KD, occurrence of other non-CAL complications, long duration of fever and IVIG resistance are associated with an increased risk for CAL in children with KD. Serum PCT and ALB have little value in the prediction of CAL in children with KD.