川崎病冠状动脉病变严重程度临床分级及高危因素研究

Clinical grading and risk factors of coronary arterial lesions in patients with Kawasaki disease

目的探讨基于临床分级的川崎病（KD）冠状动脉病变临床分级特点及不同危险等级冠状动脉病变的危险因素。方法采用回顾性调查方法，对复旦大学附属儿科医院2000年1月至2011年6月住院且病史资料完整的1253例KD患儿，依据《川崎病冠状动脉病变的临床处理建议》提出的冠状动脉病变临床分级方法，分析冠状动脉病变临床分级及病变部位特点，采用单因素和多因素Logistic回归分析发生不同临床分级冠状动脉病变的危险因素。结果（1）KD患儿急性期冠脉病变发生率为24．3％（304／1253）。根据冠状动脉病变临床分级进行分类，冠脉正常的I级病例949例，占75．7％；Ⅱ级32例，发生率2．6％；Ⅲ级251例，发生率20．O％；IV级13例，发生率1．0％；V级8例，发生率0．6％。（2）累及单支、双支、三支、四支冠状动脉者分别占冠状动脉病变患儿的42．4％、29-3％、16．1％和12．2％；发生病变的冠状动脉分支中左主干、左前降支、左回旋支、右冠状动脉病变分别占43．5％、18．6％、6．8％、31．1％。（3）多因素Logistic回归分析显示，不完全型KD、CRP〉100mg/L是Ⅱ级冠状动脉病变的独立危险因素；男性、年龄≤1岁、发热持续时间〉10d、不完全型KD、ALB〈30g/L是发生Ⅲ～V级病变的独立危险因素。结论（1）KD冠状动脉病变以Ⅲ级为最多见，占82．6％；V级最少见，占2．6％。（2）57．6％的冠状动脉病变累及二支或二支以上的冠状动脉。（3）KD冠状动脉病变部位以左冠状动脉主干最常见，其后依次为右冠状动脉、左前降支和左回旋支。（4）男性、年龄≤1岁、发热持续时间〉10d、不完全型KD、ALB〈30g/L是Ⅲ～V级冠状动脉病变的独立危险因素。

Abstract： Objective To analyze the characteristics and risk factors of coronary artery lesions （CAL） in Kawasaki dis- ease （KD） based on the clinical grading. Methods The clinical records of 1253 KD patients admitted to Children＇ s Hospital of Fudan university from January 2000 to June 2011 were analyzed retrospectively. Results （ 1 ） Coronary arte- rial lesions occurred in 304 cases with the incidence of 24.3% in KD patients. According to the clinical grading of CAL of KD, among 304 CAL patients, 32 cases （10.5%） were grade Ⅱ,251 cases （82.6%） were grade Ⅲ , 13 cases （4.3%） were grade IV, and 8 cases （2.6%） were grade V, with the prevalence in KD patients of 2.6%, 20.0%, 1.0%, and 0.64% respectively. （2）In all CAL patients, single, double, three and four coronary branch lesions accounted for 42.4%, 29.3%, 16.1% and 12.2% respectively. The lesions of left main trunk, left anterior descending branch, left circumflex branch and right coronary artery accounted for 43.5 %, 18.6%, 6.8 % and 31.1% of all the branches involved respective- ly. （3）The results of single factor analysis and multivariate logistic regression analysis showed that incomplete KD and elevated C reactive protein （ 〉 100 mg/L） were the risk factors of grade Ⅱ CAL, while male sex, age younger than 1 year, duration of fever over 10 days, incomplete KD and low serum albumin （ 〈 30 g/L） were the risk factors of Gradem ~ v CAL. Conclusions （1） Grade III CAL is the most common type in KD patients, accounting for 82.6% of CAL. （2）About 57.6% CAL occurs in two and abovet- wo branches of coronary arteries. （3）The most frequently involved branch is left main trunk, followed by right coro-nary artery, left anterior descending branch and circumflex branch. （4） Being male, age 〈 1 year old, incomplete KD, long-lasting fever （ 〉 10 d） and low serum albumin （ 〈 30 g/L） are the independent risk factors of grade Ⅲ～ V CAL.