儿童川崎病并发髋关节滑膜炎临床特征及危险因素的病例对照研究

Clinical characteristics and risk factors of Kawasaki disease complicated with hip joint synovitis:A case-control study

目的探讨川崎病(KD)并发髋关节滑膜炎(SH)的临床特点及其危险因素.方法回顾性纳入温州医科大学附属育英儿童医院KD数据库中2013年1月1日至2017年5月1日收治的连续KD住院患儿,以并发SH的KD患儿为SHKD组,未并发SH的KD患儿为KD组,分析KD患儿并发SH的可能危险因素.结果1038例KD患儿进入本文分析,SHKD组13例,KD组1025例.①SHKD组男6例,女7例,平均发病年龄(35.5±15.3)月龄,病程中第1~17(9.1±4.2)d出现滑膜炎症状.双侧SH 9例,右侧SH 2例,左侧SH 1例,髋、膝关节滑膜炎1例.采用IVIG和阿司匹林治疗KD,1例出现冠状动脉扩张,1例出现休克,3例IVIG无反应.SH症状恢复时间1~10(4.0±2.4)d.②年龄、D-二聚体和IVIG无反应发生率在两组间差异有统计学意义(P分别为0.026、0.003和0.012).③Logistic多因素回归分析显示,D-二聚体升高和IVIG无反应是KD并发SH的独立危险因素,OR值分别为1.151(95%CI:1.021~1.297)和12.2(95%CI:2.476~60.485).结论SHKD临床表现以髋关节疼痛及下肢活动受限为主,症状轻,预后良好.D-二聚体升高和IVIG无反应是SHKD的独立危险因素.

Objective To investigate the clinical characteristics and risk factors of Kawasaki disease(KD)complicated with hip joint synovitis(SH).Methods The children admitted to the KD database of Yuying Children's Hospital Affiliated to Wenzhou Medical University from January 1st,2013 to May 1st,2017 were reviewed.The case group was children with SH(SHKD group)and the control group was children without SH(KD group).The possible risk factors of SH in children with KD were analyzed.Results A total of 1,038 children with KD were included in this study,13 in SHKD group and 1,025 in KD group.In 13 cases of SHKD,there were 6 males and 7 females,the average age of onset was(35.5±15.3)months,and synovitis appeared on the 1st to 17th(9.1±4.2)day.There were 9 cases of bilateral SH,2 cases of right SH,1 case of left SH and 1 case of synovitis of hip and knee joint.After treatment with intravenous immunoglobulin(IVIG)and aspirin,coronary artery lesion(CAL)occurred in 1 case,shock occurred in 1 case,and IVIG-resistance occurred in 3 cases.The recovery time of SH symptoms was 1-10(4.0±2.4)days.Age,D-Dimer and the incidence of IVIG-resistance were statistically significant between the two groups(P-value was 0.026,0.003 and 0.012,respectively).Multivariate logistic regression analysis found that the increase of D-Dimer and IVIG-resistance were independent risk factors for SHKD,and OR was 1.151(95%CI:1.021-1.297)and 12.239(95%CI:2.476-60.485),respectively.Conclusion The clinical manifestations of SHKD were mainly hip joint pain and limited lower limb activity,with mild symptoms and a good prognosis.The increase in D-Dimer and IVIG-resistance were independent risk factors for SHKD.