不完全性川崎病患儿临床特征及冠状动脉损害情况分析

Clinical characteristics and coronary artery lesions in children with incomplete Kawasaki disease

目的探讨不完全性川崎病(IKD)患儿临床特点和冠状动脉损害(CAL)情况,以及其与完全性川崎病(CKD)患儿的差异。方法选择2018年1月至2023年12月于蚌埠医科大学第一附属医院和蚌埠医科大学第二附属医院收治的192例川崎病患儿为研究对象。根据临床确诊结果,将其分别纳入CKD组(n=114)和IKD组(n=78)。采用独立样本t检验、Mann-Whitney U检验及χ^(2)检验,对2组患儿临床表现、实验室检查及超声心动图检查结果进行统计学分析。本研究遵循的程序经蚌埠医科大学伦理委员会批准(审批文号:伦科批字〔2021〕第238号),所有患儿监护人签署临床研究知情同意书。结果①IKD组患儿年龄,结膜充血、口唇黏膜改变、多形性皮疹、四肢末端改变及颈部淋巴结大发生率,以及血红蛋白(Hb)水平,均小于、低于CKD组;而发热时间、卡疤红肿发生率及血清丙氨酸转氨酶(ALT)水平,均长于、高于CKD组,并且差异均有统计学意义(P<0.05)。②IKD组患儿被确诊时CAL发生率及随访6个月时中型或巨大冠状动脉瘤(CAA)发生率分别为29.5%、7.7%,均高于CKD组患儿的16.7%、0.9%,并且差异均有统计学意义(χ^(2)=4.45、P=0.035,P=0.019)。2组患儿被确诊时冠状动脉轻度扩张或小型CAA、中型或巨大CAA、左侧CAL(LCAL)和右侧CAL(RCAL)发生率,以及随访6个月时CAL、冠状动脉轻度扩张或小型CAA、LCAL及RCAL发生率比较,差异均无统计学意义(P>0.05)。结论相较于CKD患儿,IKD患儿发病年龄更小、Hb水平更低、发热时间更长、卡疤红肿发生率及ALT水平更高,更易并发CAL,出院后随访6个月内的CAA恢复更慢。

Objective To explore the clinical characteristics and coronary artery lesions(CAL)in children with incomplete Kawasaki disease(IKD),and the differences of those between children with IKD and children with complete Kawasaki disease(CKD).Methods A total of 192 cases of children with Kawasaki disease who were hospitalized in the First Affiliated Hospital of Bengbu Medical University and the Second Affiliated Hospital of Bengbu Medical University from January 2018 to December 2023 were selected as research subjects.They were included into CKD group(n=114)and IKD group(n=78)according to the clinical diagnosis.The differences of clinical manifestations,laboratory examination and echocardiography results between two groups of children were statistically compared by independent-samples t test,Mann-Whitney U test and chi-square test.The procedure followed in this study was approved by Ethics Committee of Bengbu Medical University(Approval No.2021-238),and all the guardians signed informed consent forms for the clinical study.Results①The age of children,and the incidence of conjunctival congestion,oral mucosal changes,pleomorphic rash,extremity changes and cervical lymphadenopathy,and hemoglobin(Hb)levels in IKD group were less or lower than those in CKD group;however,the fever duration,incidence of Bacillus Calmette-Guerin vaccine scar redness and serum alanine aminotransferase(ALT)levels were longer or higher than those in CKD group,and all these differences were statistcally significant(P<0.05).②The incidence of CAL at the time of diagnosis and the incidence of medium or giant coronary artery aneurysms(CAA)at 6 months of follow-up in IKD group were 29.5%and 7.7%,respectively,which were higher than those of 16.7%and 0.9%in CKD group,and the differences were statistically significant(χ^(2)=4.45,P=0.035;P=0.019).There were no significant differences between two groups in the incidence of mild coronary artery dilation or small CAA,medium or giant CAA,left CAL(LCAL)and right CAL(RCAL)at the time of diagnosis,and incidence of CAL,mild coronary a rtery dilation or small CAA,LCAL and RCAL at 6 months of follow-up(P>0.05).Conclusions Compared to children with CKD,children with IKD had younger age of onset,lower Hb levels,longer duration of fever,higher incidence of Bacillus Calmette-Guerin vaccine scar redness and ALT levels,were more likely to develop CAL,and slower recovery of CAA within 6 months of follow-up after discharge.