2012至2016年单中心川崎病流行病学及临床特征研究

Epidemiological and clinical features of Kawasaki disease in a single center from 2012 to 2016

目的了解川崎病(KD)患病情况及临床特征,探讨KD冠状动脉损害(CAL)及IVIG耐药的危险因素。方法回顾性分析华中科技大学同济医学院附属同济医院2012年1月1日至2016年12月31日初诊的KD患儿的临床资料,比较分析KD治疗前后,典型和不完全KD,KD伴或不伴CAL,IVIG敏感或耐药的临床特征,分析CAL发生和IVIG耐药的危险因素。结果 725例KD患儿进入本文分析,男∶女为1.61∶1,平均年龄(2.7±2.3)岁;不完全KD 206例(28.4%),典型KD 519例;CAL 216例(29.8%),IVIG耐药61例(8.4%);治疗中仅使用阿司匹林者70例(9.6%)。KD伴CAL的危险因素为IVIG耐药(OR=5.138,95%CI:1.835～14.836)和氨基末端脑钠肽前体(NT-proBNP)≥1 000 pg·m L^(-1)(OR=2.723,95%CI:1.110～6.679)。IVIG耐药的危险因素为出现CAL(OR=2. 586,95%CI:1. 067～6. 271)。结论 KD患病人数、CAL和IVIG耐药患儿有增加趋势。IVIG耐药和NT-proBNP≥1 000 pg·m L^(-1)为KD伴CAL的危险因素,而发生CAL为IVIG耐药的危险因素。

Objective To investigate the epidemological and clinical features of Kawasaki disease (KD) in Tongji Hospital Affiliated to Huazhong University of Science and Technology (our hospital) and to explore the risk factors of coronary arteries lesions(CAL) and intravenous immunoglobulin (IVIG) resistant-KD.Methods This study is a descriptive,retrospective analysis,which covered patients diagnosed with KD from January 1,2012 to December 31,2016 in our hospital.It was designed to study the epidemiological and clinical features of KD and to analyze the differences of related inflammatory and biochemical markers between typical KD and incomplete KD,KD with CAL and without CAL,IVIG-resistant KD and IVIG-sensitive KD.Results There were 725 patients with KD as the primary diagnosis.The median age was (2.7±2.3) years.Among all children,206 (28.4%) cases were incomplete KD and 509 (71.6%) cases were typical KD.A total of 216 (29.8%) had coronary arteries abnormality and 61 (8.41%) was diagnosed with IVIG-resistant KD.There were 70 cases (9.6%) of KD without the treatment of IVIG.Logistic regression showed that IVIG resistance (OR=5.138,95%CI:1.835~14.836,P=0.002) and higher level of brain natriuretic peptide (NT-proBNP≥1 000 pg·mL^-1 )(OR=2.723,95%CI:1.110-6.679,P=0.029) were the risk factors of CAL.Also,it presented that the risk factors of IVIG-resistant KD was CAL (OR=2.586,95%CI:1.067-6.271,P=0.035).Conclusion It showed that the incidence of KD is increasing gradually,as well as the incidence of CAL and IVIG-resistant KD in our hospital.IVIG resistance and high levels of BNP (NT-proBNP≥1 000 pg·mL^-1 ) are the risk factors of coronary arteries lesions.Meanwhile,KD with CAL is the risk factor of IVIG-resistant KD.