川崎病休克综合征的临床特点及危险因素分析

Clinical manifestations and risk factors of Kawasaki disease shock syndrome

目的分析川崎病休克综合征(KDSS)的临床特点及危险因素,以改善其预后。方法本研究纳入2009年1月至2013年12月在温州医科大学附属育英儿童医院诊断为KDSS的患儿8例(KDSS组),收集同一时期确诊为川崎病(血流动力学稳定)的患儿32例作为对照组。分析两组患者的临床特点、实验室检查、治疗及预后,采用Logistic回归分析法分析KDSS的独立危险因素。结果与对照组相比,KDSS组患儿年龄>3岁(75.0%vs.21.9%,χ2=8.23,P<0.05),淋巴结肿大发生率(87.5%vs.40.6%,χ2=5.48,P<0.05)较高,中性粒细胞比例[(0.90±0.04)%vs.(0.66±0.15)%,t=8.42,P<0.05],C反应蛋白[(221±116)mg/L vs.(73±54)mg/L,t=3.52,P<0.05],N末端脑利钠肽前体(NT-pro BNP)水平[(6 192±2 990)×10-6 mg/L vs.(739±691)×10-6 mg/L,t=5.12,P<0.05]较高,白蛋白[(22±4)g/L vs.(31±4)g/L,t=5.69,P<0.05]及血钠水平[(126.0±7.7)mmol/L vs.(135.6±2.2)mmol/L,t=3.49,P<0.05]较低,且易发生丙球无反应(62.5%vs.6.3%,χ2=14.49,P<0.05)及冠脉损害(87.5%vs.28.1%,χ2=9.17,P<0.05)。Logistic回归分析显示,患儿年龄>3岁[OR=10.7,95%CI(1.8,65.2)],中性粒细胞比例>0.75[OR=17.9,95%CI(1.9,166.8)],白蛋白<30 g/L[OR=11.7,95%CI(1.3,106.8)]及NT-pro BNP升高[OR=29.0,95%CI(4.0,212.9)]是KDSS的独立危险因素(P均<0.05)。结论 KDSS患儿年龄较大,全身炎症反应明显,有低蛋白血症,NT-pro BNP升高,且易导致丙球无反应及冠状动脉损害。

Objective To investigate the clinical characteristics and risk factors of Kawasaki disease shock syndrome（KDSS）, therefore to improve its prognosis. Methods Eight patients with KDSS（KDSS group） and 32 Kawasaki disease patients（hemodynamically stable）（control group） from the Second Affiliated Hospital of Wenzhou Medical University between January 2009 and December 2013 were enrolled in the study. The clinical features, laboratory examination, treatment and prognosis of all the patients were observed and compared between the two groups, and the independent risk factors of KDSS were analyzed by Logistic regression.Results The age of onset of the patients in the KDSS group were older than that in the control group. Compared with the control group, the age of onset 3 years（75.0% vs. 21.9%, χ2=8.23,P 0.05）, the incidence rate of lymphadenectasis（87.5% vs.40.6%, χ2 = 5.48,P 0.05）, the levels of percentage of neutrophils[（0.90 ± 0.04）% vs.（0.66 ± 0.15）%, t = 8.42, P 0.05], C reactive protein [（221 ± 116） mg / L vs.（73 ± 54） mg / L, t = 3.52, P 0.05] and N-terminal probrain natriuretic peptide（NT-pro BNP） levels [（6 192 ± 2 990） × 10-6mg / L vs.（739 ± 691） × 10-6mg / L, t = 5.12, P 0.05] of patients in the KDSS group were higher, while the serum albumin [（22 ± 4） g / L vs.（31 ± 4）g / L, t = 5.69, P 0.05] and sodium levels [（126.0 ± 7.7） mmol / L vs.（135.6 ± 2.2） mmol / L,t = 3.49, P 0.05] were significantly lower. The rate of heart damage was statistically higher in the KDSS group than in the control group, so that gammaglobulin unresponsive（62.5% vs. 6.3%,χ2= 14.49, P 0.05） and coronary dilatation（87.5% vs. 28.1%, χ2= 9.17, P 0.05） were occurred easily. Logistic regression showed that the independent risk factors of KDSS were age of onset 3 years [OR = 10.7, 95%CI（1.8, 65.2）, P 0.05], percentage of neutrophils 0.75 [OR = 17.9,95%CI（1.9, 166.8）, P 0.05], albumine 30 g / L [OR = 11.7, 95%CI（1.3, 106.8）, P 0.05] and higher level of NT-pro BNP[OR = 29.0,95%CI（4.0, 212.9）, P 0.05]. Conclusion KDSS patients had older age of onset, obvious systemic inflammatory reaction, hypoproteinemia and higher level of NT-BNP, resulting in gammaglobulin unresponsive and coronary artery lesions.