川崎病合并中小型冠状动脉瘤持续时间危险因素分析

Analysis of risk factors for duration of small or medium-sized coronary artery aneurysms in children with Kawasaki diseas

目的分析川崎病(KD)患儿合并中小型冠状动脉瘤(CAA)持续时间的高危因素, 为早期、足疗程治疗提供临床指导。方法回顾性分析2018年1月至2021年1月在新乡医学院第一附属医院儿科确诊为KD的68例患儿临床资料, 根据CAA持续时间分为CAA持续时间≥8周组及CAA持续时间<8周组, 采用单因素分析筛选出与CAA持续时间相关危险因素, 进而采用多因素Logistic回归分析KD患儿CAA持续时间的独立危险因素。结果 68例住院KD患儿中, 男45例(66.18%), 女23例(33.82%);发病年龄3个月~10岁, 中位发病年龄1.59(1.02~3.19)岁。CAA持续时间≥8周组31例, CAA持续时间<8周组37例。单因素分析发现, CAA持续时间≥8周组总热程>10 d[45.16%(14/31例)比21.62%(8/37例)]、静脉注射免疫球蛋白(IVIG)前病程>10 d[54.84%(17/31例)比16.22%(6/37例)]、血小板计数>600×109/L[32.26%(10/31例)比10.81%(4/37例)]、超敏C反应蛋白>100 mg/L[38.71%(12/31例)比13.51%(5/37例)]者显著多于CAA持续时间<8周组, 2组比较差异均有统计学意义(均P<0.05);2组间性别、年龄、KD类型、病原学证据、激素应用情况、IVIG应用前热程、IVIG敏感情况、IVIG应用方式、尿白细胞情况、白细胞计数、血红蛋白、中性粒细胞比例、红细胞沉降率、谷丙转氨酶比较, 差异均无统计学意义(均P>0.05)。多因素Logistic回归分析提示IVIG应用前病程>10 d(OR=6.589, 95%CI:1.678~25.867, P=0.007)、超敏C反应蛋白>100 mg/L(OR=7.949, 95%CI:1.947~32.461, P=0.004)分别为预测KD合并中小型CAA持续时间≥8周的独立危险因素。结论 IVIG应用前病程>10 d及超敏C反应蛋白>100 mg/L是KD合并中小型CAA持续时间≥8周的独立危险因素。

Objective To analyze risk factors for duration of small or medium-sized coronary artery aneurysms(CAA)in children with Kawasaki disease(KD)so as to provide clinical guidance for early and full course treatment.Methods The clinical data of 68 children diagnosed with KD in the Department of Pediatrics,the First Affiliated Hospital of Xinxiang Medical University from January 2018 to January 2021 were retrospectively analyzed.According to duration of CAA,all cases were divided into 2 groups,duration of CAA≥8 weeks group and duration of CAA<8 weeks group.Risk factors associated with CAA duration were screened using univariate analysis,and then independent risk factors for CAA duration in children with KD were analysed using multiple Logistic regression analysis.Results A total of 68 cases were enrolled in this study.Among these cases,45 cases(66.18%)were male and 23 cases(33.82%)were female.The onset age was from 3 months to 10 years old,and the median onset age was 1.59(1.02-3.19).There were 31 cases in the group with CAA duration≥8 weeks and 37 cases in the group with CAA duration<8 weeks.Univariate analysis showed that patients with the total fever course>10 days[45.16%(14/31 cases)vs.21.62%(8/37 cases)],time of treatment with intravenous immunoglobulin(IVIG)>10 days[54.84%(17/31 cases)vs.16.22%(6/37 cases)],platelet(PLT)>600×109/L[32.26%(10/31 cases)vs.10.81%(4/37 cases)],hypersensitive C-reactive protein(HsCRP)>100 mg/L[38.71%(12/31 cases)vs.13.51%(5/37 cases)](all P<0.05)in the group with CAA duration≥8 weeks were significantly more than those in the group with CAA duration<8 weeks.However,there were no significant differences in gender,age,type of KD,etiology evidence,hormone application,duration of fever before IVIG application,IVIG sensitivity,IVIG application way,urine leukocytes,white blood cells,hemoglobin,percent of neutrophilic granulocyte,erythrocyte sedimentation rate,glutamic-pyruvic transaminase between the 2 groups(all P>0.05).Multivariate Logistic regression analysis showed that the course of IVIG before application>10 days(OR=6.589,95%CI:1.678-25.867,P=0.007)and HsCRP>100 mg/L(OR=7.949,95%CI:1.947-32.461,P=0.004)were independent risk factors for predicting the duration of KD complicated with small and medium-sized CAA≥8 weeks.Conclusions The course of IVIG before application>10 days and HsCRP>100 mg/L are independent risk factors for KD complicated with small and medium-sized CAA lasting≥8 weeks.