川崎病合并肝功能异常患儿临床分析

Clinical analysis of children with Kawasaki disease complicated with abnormal liver function

目的探讨川崎病合并肝功能异常患儿的临床资料及预后相关因素。方法收集杭州市儿童医院2020年9月—2022年2月收治的147例川崎病患儿的临床资料,依据肝功能是否损害分为肝功能异常组和肝功能正常组。比较两组患儿性别、年龄、住院时间、入院后血清白蛋白、总胆红素(TB)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆汁酸、白细胞计数(WBC)、血红蛋白(Hb)、血小板(PLT)、超敏C-反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)、红细胞沉降率(ESR)、静注丙种球蛋白(IVIG)无应答发生率、不完全川崎病及冠状动脉病变(CAL)发生情况有无差异。结果147例川崎病患儿中肝功能正常组104例,肝功能异常组43例,肝功能异常发生率为29.25%。肝功能异常组炎症相关指标WBC、CRP、PCT及IL-6水平显著高于肝功能正常组,差异均有统计学意义(均P<0.05)。肝功能正常组与肝功能异常组CAL及不完全川崎病发生情况比较,差异无统计学意义(P>0.05)。肝功能异常组IVIG无应答发生率为23.26%(10/43),显著高于肝功能正常组的8.65%(9/104),两组比较差异有统计学意义(P<0.05)。通过logistic回归分析显示,IL-6与PCT为IVIG无应答的独立危险因素。肝功能异常组住院时间明显长于肝功能正常组,差异有统计学意义(P<0.05)。结论该研究急性期川崎病患儿肝功能异常发生率为29.25%,且肝功能异常组患儿WBC、CRP、PCT及IL-6水平较肝功能正常组更高。肝功能异常组患儿IVIG无应答发生率更高,IL-6及PCT是IVIG无应答的独立危险因素。临床工作中应重视川崎病合并肝功能损害,当IL-6、PCT水平异常增高时,警惕IVIG无应答。

Objective To explore the clinical data and prognostic factors of children with Kawasaki disease(KD)complicated with abnormal liver function.Methods The clinical data of 147 children with Kawasaki disease treated in our hospital from September 2020 to February 2022 were collected.According to whether the liver function was damaged,they were divided into abnormal liver function group and normal liver function group.The gender,age,length of hospital stays,serum albumin,total bilirubin(TB),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),total bile acid,leukocyte(WBC),hemoglobin(HB),platelet(PLT),high-sensitivity C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),intravenous immunoglobulin(IVIG)non-response rate,incomplete Kawasaki disease and coronary artery lesions(CAL)were compared between the two groups.Results Among 147 children,104 children had normal liver function and 43 children had abnormal liver function,the incidence of abnormal liver function was 29.25%.The difference between the two groups in WBC,CRP,PCT and IL-6 were statistically significant(P<0.05).There were nostatistically significant difference between the two groups in CAL and incomplete Kawasaki disease(P>0.05).The incidence of IVIG non-response in abnormal liver function group was 23.26%(10/43),which was significantly higher than that in normal liver function group(8.65%,9/104),and the difference was statistically significant(P<0.05).Logistic regression analysis showed that IL-6 and PCT were independent risk factors for IVIG non-response.The length of hospital stay in abnormal liver function group was significantly longer than that in normal liver function group,the difference was statistically significant(P<0.05).Conclusion In this study,the incidence of abnormal liver function in children with acute Kawasaki disease was 29.25%,and the levels of WBC,CRP,PCT and IL-6 in children with abnormal liver function group were higher than those in normal liver function group.The incidence of IVIG nonresponse was higher in the abnormal liver function group,and IL-6 and PCT were independent risk factors for IVIG non-response.In clinical work,attention should be paid to Kawasaki disease complicated with liver function damage.When the level of IL-6 and PCT abnormally increases,it should be warned that IVIG non-response.