川崎病患儿并发冠状动脉病变的危险因素分析

Risk factors for coronary artery lesions in children with Kawasaki disease

目的探讨川崎病(KD)并发冠状动脉病变(CAL)的危险因素。方法收集2006年1月至2012年1月间诊断为KD的527例患儿的临床资料,对15个可能与CAL发生有关的因素进行单因素和多因素logistic回归分析。结果单因素分析显示,患儿年龄、性别、KD类型、大剂量丙种球蛋白(IVIG)治疗起始时间、对IVIG治疗的反应、使用糖皮质激素、发热持续时间及C反应蛋白等因素在合并和未合并CAL两组患儿中差异有统计学意义(P<0.05)。进一步多因素logistic回归分析显示,年龄<1岁和>8岁、男性、非典型KD、IVIG治疗开始于发热后10 d以上、对IVIG治疗无反应、发热持续时间>10 d为CAL发生的独立危险因素(OR分别为2.076、1.890、1.972、1.426、3.251、2.301、1.694,均P<0.05),IVIG治疗起始时间<5 d为CAL的保护性因素(OR=0.248,P<0.05)。结论 KD患儿CAL的发生与多种因素有关,年龄(<1岁和>8岁)、男性、非典型KD、IVIG治疗起始时间较晚、对IVIG治疗无反应、发热持续时间较长是CAL发生的独立危险因素。

Objective To study risk factors for the development of coronary artery lesions（CAL） in children with Kawasaki disease（KD）.Methods The clinical data of 527 children with KD between January 2006 and January 2009 were retrospectively reviewed.A total of 15 potential factors associated with occurrence of CAL were evaluated by univariate analysis and multivariate logistic regression analysis.Results The univariate analysis showed that age,gender,KD type,starting time of intravenous immunoglobulin（IVIG） treatment,response to IVIG treatment,additional treatment with corticosteroids,duration of fever and serum C-reactive protein level were significantly different between patients with and without CAL（P〈0.05）.Multivariate logistic regression analysis showed that an age of less than 1 year（OR=2.076,P〈0.05） or greater than 8 years（OR=1.890,P〈0.05）,male sex（OR=1.972,P〈0.05）,incomplete KD（OR=1.426,P〈0.05）,delayed starting time of IVIG treatment（10 days after onset）（OR=3.251,P〈0.05）,no response to IVIG（OR=2.301,P〈0.05） and fever duration of more than 10 days（OR=1.694,P〈0.05） were independent risk factors for the development of CAL,whereas early starting time of IVIG treatment（before 5 days after onset） was a protective factor（OR=0.248,P〈0.05）.Conclusions The occurrence of CAL is associated with many factors in children with KD.Age of less than 1 year or greater than 8 years,male sex,incomplete KD,delayed IVIG treatment after onset,no response to IVIG treatment and prolonged fever duration have been identified as risk factors for the development of CAL.