儿童川崎病合并冠状动脉病变的转归及影响因素分析

Outcome and influencing factors of coronary artery lesion in children with Kawasaki disease

目的评估川崎病(KD)不冠脉分支冠状动脉病变(CAL)的转归情况,并分析CAL结局相关影响因素。方法回顾性分析2017年1月至2020年11月在温州医科大学附属第二医院(育英儿童医院)确诊KD且在急性期(病程2周内)并发CAL的332名患儿,共计574支冠状动脉数据。对影响CAL转归的90项因素进行单因素分析,将不同冠脉分支存在显著性差异的因素纳入COX回归分析。结果在病程3月时65.3%冠脉可恢复正常,至病程24月CAL消退率达90.9%,所有冠脉的CAL中位消退时间为病程3月。不同冠脉分支CAL转归的COX回归分析表明,右冠状动脉CAL在病程24月的不良结局独立危险因素为IVIG延迟治疗,而IVIG治疗后血小板体积分布宽度与IVIG治疗前白球比分别为左冠状动脉主干和左前降支CAL结局的独立保护因素。结论IVIG延迟治疗与右冠状动脉CAL最终的不良结局独立相关,IVIG治疗后血小板体积分布宽度、IVIG治疗前白球比的升高则可分别降低左冠状动脉主干CAL和左前降支CAL持续的风险。

Objective To evaluate the prognosis of coronary artery lesion(CAL)in Kawasaki disease(KD)and analyze the influencing factors of CAL outcomes.Methods A retrospective analysis was performed for 332 children with KD in our hospital from January 2017 to November 2020,and complicated by CAL in the acute stage(within 2 weeks of the course of the disease),with a total of 574 coronary artery data.Univariate analysis was performed on 90 factors affecting CAL outcomes,and factors with significant differences in different coronary branches were included in COX regression analysis.Results 65.3%of the coronary arteries could return to normal in the 3rd month of the disease course,and the CAL regression rate reached 90.9%by 24 months of the disease course,and the median CAL resolution time of all coronary arteries was 3 months.COX regression analysis of CAL outcomes in different coronary branches showed that the independent risk factor for the adverse outcome of right coronary CAL at 24 months was delayed treatment of IVIG,and the width of platelet volume distribution after IVIG treatment and the ratio of white balls before IVIG treatment were independent protective factors for the outcomes of left coronary trunk and left anterior descending branch CAL,respectively.Conclusion Delayed treatment with IVIG was independently associated with adverse CAL outcomes in RCA from the acute phase to 24 months after onset.Increased platelet volume distribution width after IVIG treatment and increased white bulb ratio before IVIG treatment reduced the risk of CAL persistence in the LMCA and LAD,respectively.