重症川崎病患儿的临床特点及预测指标分析

Clinical manifestations and predictors of severe Kawasaki Disease

目的通过分析重症川崎病(SKD)患儿的临床特点及预测指标,寻找早期识别SKD患儿的预测指标,为临床上早期识别SKD患儿,制定治疗及随访方案、判断预后提供帮助。方法回顾性分析2010年1月至2015年12月因出现单个或多个脏器严重损害,生命体征不平稳的住院患儿19例作为SKD组,收集同一时期确诊为川崎病(KD),但无严重脏器功能损害,生命体征平稳的76例普通KD(OKD)作为OKD组。分析其临床特征、实验室检查、辅助检查指标,治疗过程及预后情况,采用ROC曲线及多因素logistic回归分析SKD的危险因素。结果与OKD组相比,SKD组患儿年龄偏大,淋巴结肿大发生率较高,中性粒细胞比值及C反应蛋白(CRP)水平升高更为显著,转氨酶、胆红素水平更高,白蛋白及血清钠水平更低,更易发生丙种球蛋白无反应及冠状动脉损害(P<0.05或0.01)。ROC曲线分析及多因素logistic回归表明,年龄≥37.5个月,中性粒细胞比值≥82.1%,TBil≥22.05μmol/L和血清钠≤133.35mmol/L的KD患儿更易出现多脏器功能损害,生命体征不稳,是SKD的高危因素(P<0.05或0.01)。结论年龄较大的儿童,较高的嗜中性粒细胞比值,较高的胆红素水平,较低的血钠水平可能有助于预测SKD。SKD患儿丙种球蛋白无反应及冠状动脉损害风险较高。

Objective To analyze the clinical manifestations and predictors of severe Kawasaki disease(SKD).Methods Nineteen pediatric KD patients with single or multiple severe organ damage and unstable vital signs,and76KD children without organ damage and stable vital signs(control group)admitted during2010-2015were enrolled in the study.Clinical manifestations,laboratory findings,treatment and prognosis were reviewed.The risk factors of severe Kawasaki disease were analyzed by ROC curve and multivariate Logistic regression.Results The average age of SKD patients was older than that of control group(P<0.05).SKD patients were more likely to have lymphadenitis,higher neutrophil counts,C-reactive protein,transaminase and bilirubin levels,lower serumsodiumand albumin levels,a higher risk of coronary artery lesion,and no responseto intravenous immunoglobulin(IVIG)therapy(all P<0.05).Furthermore,ROC curve and Multivariate Logistic regression analysis showed that age(≥37.5months),percentage of neutrophils(N≥0.821),TBil(≥22.05滋mol/L),and serum sodium(≤133.55mmol/L)were independent predictors for SKD.Conclusion Older children,higher percentage of neutrophils,higher bilirubin,lower sodiumlevel might be used for predicting SKD.And SKD patients had a higher risk of coronary artery lesion and resistance to IVIG therapy.