杭州市2014-2018年川崎病患儿流行病学调查及并发冠状动脉损害危险因素分析

Epidemiological investigation of Kawasaki disease in children and analysis of risk factors for complicated with coronary artery damage in Hangzhou, 2014-2018

目的了解2014-2018年杭州市儿童川崎病(KD)流行情况,分析KD并发冠状动脉损害的危险因素,为杭州市儿童KD防治及预防KD患儿冠状动脉损害提供参考。方法对2014年1月-2018年12月杭州市22家综合医院诊断为KD的485例患儿临床资料进行分析,分析KD流行情况。计数资料应用χ~2检验,计量资料应用t检验,采用单因素和多因素Logistic回归模型分析KD并发冠状动脉损害的危险因素。结果杭州市KD发病人数呈逐年升高趋势,各年差异有统计学意义(P<0.05);4-6月发病人数最多,占38.97%。城市278例(57.32%),城郊134例(27.63%),农村73例(15.05%)。男性占62.47%,女性占37.53%;发病年龄构成中,1~2岁最高,占32.58%。单因素分析显示,冠状动脉损害组发热时间>10 d、心电图异常、白细胞计数>20×10^9/L、血小板>450×10^9/L、C反应蛋白>30 mg/L、血沉>100 mm/h、血钠≤135 mmol/L、血清白蛋白≤35 g/L、激素治疗、IVIG开始治疗时间>10d的比例显著高于非冠状动脉损害组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,心电图异常、白细胞计数>20×10^9/L、血小板计数>450×10^9/L、血清白蛋白≤35 g/L、IVIG开始治疗时间>10d是KD并发冠状动脉损害的危险因素(P<0.05)。结论近年杭州市儿童KD发病人数呈逐年升高趋势,KD患儿冠状动脉损害受到多种因素的影响。临床应重视以上因素并予以适当的干预,以防止KD患儿冠状动脉损害的发生。另外,应通过加强宣传教育、定期组织体检等措施对杭州市儿童KD进行防治。

Objective To understand the prevalence of Kawasaki disease(KD) in children in Hangzhou from 2014 to 2018 and to analyze the risk factors for KD complicated with coronary artery damage, and to provide reference for the prevention and treatment of KD and KD complicated with coronary artery damage in children in Hangzhou. Methods The clinical data of 485 children with KD diagnosed in 22 general hospitals in Hangzhou from January 2014 to December 2018 were analyzed and the prevalence of KD was analyzed. Chi-square test was used for counting data and t test was used for measurement data, the risk factors of KD complicated with coronary artery damage were analyzed by univariate and multivariate logistic regression analysis. Results The number of KD cases increased year by year in Hangzhou, the difference was statistically significant in each year(P<0.05). The number of patients was the highest from April to June, accounting for 38.97%. There were 278 cases(57.32%) in cities, 134 cases(27.63%) in suburbs and 73 cases(15.05%) in rural areas. Male accounted for 62.47%, and female accounted for 37.53%;the highest age of onset was 1-2 years old, accounting for 32.58%. Univariate analysis showed that the proportion of fever time>10 days, abnormal electrocardiogram, white blood cell count>20×10^9/L, platelet>450×10^9/L, C-reactive protein>30 mg/L, ESR>100 mm/h, blood sodium≤135 mmol/L, serum albumin≤35 g/L, hormone therapy, IVIG start time>10 days in coronary artery damage group were significantly higher than that in non-coronary artery group, the differences were statistically significant(P<0.05). Multivariate logistic regression analysis showed that abnormal electrocardiogram, white blood cell count>20×10^9/L, platelet count>450×10^9/L, serum albumin≤35 g/L and IVIG start time>10 days were the risk factors for KD complicated with coronary artery damage(P<0.05). Conclusion In recent years, the incidence of KD in children in Hangzhou has been increasing year by year. KD complicated with coronary artery damage in children is affected by many factors. It is necessary to pay much more attention to the above factors and give appropriate intervention to prevent KD complicated with coronary artery damage in children. In addition, it is necessary to strengthen publicity and education, and to organize regular physical examination and other measures to prevent and control KD in children in Hangzhou.