川崎病急性期肝损害与冠状动脉损伤和免疫球蛋白无反应的关系

Association of liver damage with coronary artery lesion and no response to intravenous immunoglobulin in the acute stage of Kawasaki disease

摘要:

目的 总结川崎病（Kawasaki disease，KD）患儿急性期肝损害的临床特点，分析肝损害在预测KD患儿发生冠状动脉损伤及静脉注射免疫球蛋白（intravenous immunoglobulin，IVIG）治疗无反应中的临床价值。 方法 收集2016年1月1日至2017年12月31日在北京儿童医院首次确诊为KD的925例住院患儿的临床资料，按照入院时有无丙氨酸氨基转移酶（alanine transaminase，ALT）水平异常分为肝损害组（n=284）和非肝损害组（n=641），应用logistic回归分析肝损害等指标预测KD患儿冠状动脉损伤及IVIG无反应的临床价值。 结果 肝损害组KD患儿入院时间较非肝损害组更早，血清炎性指标水平更高（P<0.05）。肝损害组KD患儿入院时冠状动脉损伤发生率高于非肝损害组（P=0.034）；给予首次IVIG治疗后，肝损害组发生IVIG无反应的比例显著高于非肝损害组（P<0.001）。KD患儿发生冠状动脉损伤与血红蛋白水平下降、血小板计数升高、C反应蛋白水平升高和ALT水平升高有关（P<0.05）；KD患儿发生IVIG无反应与四肢改变、血红蛋白水平下降、血小板计数升高、C反应蛋白水平升高、ALT水平升高及冠状动脉损伤有关（P<0.05）。 结论 KD急性期合并肝损害患儿的临床症状出现早且炎性指标水平更高，更容易发生冠状动脉损伤及IVIG治疗无反应。 用

Abstract:

Objective To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD. Methods The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (n=284) and a non-liver damage group (n=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD. Results Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (P<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (P=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (P<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (P<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (P<0.05). Conclusions Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.