儿童川崎病冠状动脉损伤危险因素分析

Analysis of risk factors for coronary artery injury in children with Kawasaki disease

目的调查儿童川崎病(KD)冠状动脉损伤发生情况,并进行危险因素分析。方法选择2018年1月—2022年12月在泉州市妇幼保健院儿童医院诊治的KD儿童782例为研究对象,所有患儿在入院时均给予超声检查,判定冠状动脉损伤情况,调查所有患儿的一般资料,进行危险因素分析。结果782例患儿中,超声判断为冠状动脉损伤171例,占比21.9%(冠脉损伤组),无冠状动脉损伤611例(无冠脉损伤组)。冠脉损伤组的皮疹、肢端硬性红肿、球结膜充血、杨梅舌等临床表现占比分别为83.6%、67.8%、86.0%、81.9%,高于无冠脉损伤组的63.5%、49.7%、62.5%、65.3%(P<0.05)。冠脉损伤组与无冠脉损伤组的性别、年龄、血红蛋白、血红细胞沉降率(ESR)等比较差异无统计学意义(P>0.05),冠脉损伤组的丙氨酸氨基转移酶、白细胞计数(WBC)、D-二聚体(D-D)、C-反应蛋白(CRP)、降钙素原(PCT)、血小板计数(PLT)、发热时间与无冠脉损伤组比较差异有统计学意义(P<0.05)。多因素Logistic逐步回归分析显示,WBC、D-D、CRP、PCT、PLT、发热时间均为川崎病患儿发生冠状动脉损伤的影响因素(P<0.05)。结论KD儿童中,冠状动脉损伤发生率较高,可导致患儿临床特征多样化,加重患儿的病情,WBC、D-D、CRP、PCT、PLT、发热时间为导致冠状动脉损伤发生的影响因素。

Objective To investigate the incidence of coronary artery injury in children with Kawasaki disease(KD)and analyze the risk factors.Methods From January 2018 to December 2022,782 children with KD diagnosed and treated in Quanzhou Women’s and Children’s Hospital were selected as the study subjects.All the children were given ultrasound examination on admission to determine the coronary artery injury level.The general information of all the children was investigated and the risk factors were analyzed.Results Among the 782 children,171 cases(21.9%)were diagnosed as the“coronary artery injury group”.The remaining 611 patients did not exhibit any coronary artery injury and were thus categorized as the“no coronary artery injury group”.The clinical manifestations incidences of rashes,hard red swelling of extremity,bulbar conjunctival congestion and bayberry tongue in the coronary injury group were 83.6%,67.8%,86.0%and 81.9%,respectively,which were significantly higher than those in the non-coronary injury group(63.5%,49.7%,62.5%and 65.3%,P<0.05).There were no significant differences in gender,age,hemoglobin and erythrocyte sedimentation rate between the coronary injury group and the no coronary injury group(P>0.05).There were significant differences in alanine aminotransferase,white blood cell count(WBC),D-dimer(D-D),C-reactive protein(CRP),procalcitonin(PCT),platelet count(PLT)and fever duration between the two groups(P<0.05).Multivariate Logistic stepwise regression analysis showed that WBC,D-D,CRP,PCT and PLT were all important factors leading to coronary artery injury(P<0.05).Conclusions The incidence of coronary artery injury in children with KD is relatively high,which can lead to the diversification of clinical features and disease aggravation of children.WBC,D-D,CRP,PCT,PLT and fever duration are important risk factors for the occurrence of coronary artery injury.