川崎病延迟治疗冠状动脉损害相关危险因素分析

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Abstract Objective: To identify the risk factors for coronary artery lesions with intravenous immunoglobulin (IVIG) treatment of Kawasaki disease (KD) >10 days after onset at different status. Methods: Nine hundred and thirty patients diagnosed as KD were collected from January 2009 to December 2014 at the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University. Patients were divided into the delayed IVIG therapy group (who received IVIG treatment after 10 days) and the conventional therapy group (who received IVIG treatment within 10 days). Coronary artery lesions between the two groups were compared. Risk factors for coronary artery lesions were investigated. Results: In the delayed IVIG therapy group, the frequency of coronary artery lesions within 1 month was higher (42.4% vs. 17.7%, P<0.001). The interaction analysis indicated that delayed IVIG therapy children with higher level of C-reaction protein (CRP, >79 mg/L, OR=5.68, 95%CI: 1.17-27.59, P<0.05), erythrocyte sedimentation rate (ESR, >34 mm/h, OR=4.11, 95%CI: 1.62-10.46, P<0.05), neutrophils and aspartate transaminase had higher risk to develop coronary artery lesions. Delayed IVIG therapy with lower level of albumine, red blood cell also had higher risk to develop coronary artery lesions. Compared with controventional therapy group without changing of departement, the delayed therapy with changing of department had higher risk to develop coronary artery lesions (OR=7.29, 95%CI: 1.85-45.17, P=0.0327). Conclusion: Delayed IVIG treatment leads to increased risk of coronary artery lesions in KD children. Delayd IVIG treatment combined with higher level of CRP, ESR, neutrophils, aspartate transaminase, lower level of red blood cell and not admitted to cardiology department at initial time has higher risk to develop coronary artery lesions.

Key words： Kawasaki disease coronary artery lesions gamma-globulins delayed therapy C-reaction protein erythrocyte sedimentation rate

Received: 07 August 2017

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	QIU Huixian
	SHI Hongying
	HE Yuee
	RONG Xing
	WU Rongzhou
	CHU Maoping.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2018/V48/I2/96

[1] ELEFTHERIOU D, LEVIN M, SHINGADIA D, et al. Management of Kawasaki disease[J]. Arch Dis Child, 2014, 99(1): 74-83.
[2] JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008)——digest version[J]. Circ J, 2010, 74(9): 1989-2020.
[3] HIROMI M M, ASAHIRO I, MAYUMI Y, et al. Late intravenous immunoglobulin treatment in patients with Kawasaki disease[J]. Pedatrics, 2012, 129(2): e291-e297.
[4] NEWBURGER J W, TAKAHASHI M, GERBER M A, et al. Diagnosis, treatment, and long term management of Kawasaki disease: a statement for health professionals from committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association[J]. Pediatrics, 2004, 114(6): 1708-1733.
[5] 胡亚美, 江载芳. 实用儿科学[M]. 7版. 北京: 人民卫生出版社, 2002: 698-705.
[6] 何跃娥, 褚茂平, 张园海, 等. 氧化型低密度脂蛋白与川崎病冠状动脉损害的相关性[J]. 温州医科大学学报, 2017, 47(1): 19-22.
[7] ANDERSON M S, TODD J K, GLODÉ M P. Delayed diagnosis of Kawasaki syndrome: an analysis of the problem[J]. Pediatrics, 2005, 115(4): e428-433.
[8] MINICH L L, SLEEPER L A, ATZ A M, et al. Pediatric Heart Network Investigators. Delayed diagnosis of Kawasaki disease: what are the risk factors?[J]. Pediatrics, 2007, 120(6): e1434-1440.
[9] WILDER M S, PALINKAS L A, KAO A S, et al. Delayed diagnosis by physicians contributes to the development of coronary artery aneurysms in children with Kawasaki syn-drome[J]. Pediatr Infect Dis J, 2007, 26(3): 256-260.
[10] JUAN C C, HWANG B, LEE P C, et al. The clinical manifestations and risk factors of delayed diagnosis of Kawasaki disease[J]. J Chin Med Assoc, 2007, 70(9): 374-379.
[11] 杜忠东, 赵地, 杜军保, 等. 静脉注射丙种球蛋白应用时间对川崎病疗效的影响[J]. 中华医学杂志, 2009: 89(26): 1841-1843.
[12] SITTIWANGKUL R, PONGPROT Y, SILVILAIRAT S,
et al. Delayed diagnosis of Kawasaki disease: risk factors and outcome of treatment[J]. Ann Trop Paediatr, 2011, 31 (2): 109-114.
[13] BAL A K, PRASAD D, UMALI PAMINTUAN M A, et al. Timing of intravenous immunoglobulin treatment and risk of coronary artery abnormalities in children with Kawasaki disease[J]. Pediatr Neonatol, 2014, 55(5): 387-392.
[14] SONOBE T, KIYOSAWA N, TSUCHIYA K, et al. Prevalence of coronary artery abnormality in incomplete Kawasaki disease[J]. Pediatr Int, 2007, 49(4): 421-426.
[15] MATSUBARA K, FUKAYA T. The role of superantigens of group A Streptococcus and Staphylococcus aureus in Kawasaki disease[J]. Curr Opin Infect Dis, 2007, 20(3): 298-303.
[16] 张倩, 项如莲, 张园海, 等. 246例川崎病患儿冠状动脉损害的影响因素分析[J]. 温州医学院学报, 2008, 38(5): 467-469.
[17] JAE-JUNG K, YOUNG M H, SIN W Y. et al. Assessment of risk factors for Korean children with Kawasaki disease[J].Pediatr Cardiol, 2012, 33(4): 513-520.
[18] KUO H C, YANG Y L, CHUANG H, et al. Inflammation-induced hepcidin is associated with the development of anemia and coronary artery lesions in Kawasaki disease[J]. J Clin Immunol, 2012, 32(4): 746-752.
[19] KOBAYASHI T, SAJI T, OTANI T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial[J].Lancet, 2012, 379(9826): 1613-1620.