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中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (04) : 446 -451. doi: 10.3877/cma.j.issn.1673-5250.2024.04.012

论 著

不完全性川崎病患儿临床特征及冠状动脉损害情况分析
顾盼盼1,2, 董传莉2, 宋梦瑶1, 瞿色华1, 杨小迪3, 周瑞1,()   
  1. 1.蚌埠医科大学第一附属医院儿科,蚌埠 233004
    2.蚌埠医科大学第二附属医院儿科,蚌埠 233000
    3.蚌埠医科大学基础医学院,蚌埠 233030
  • 收稿日期:2024-06-18 修回日期:2024-07-17 出版日期:2024-08-01
  • 通信作者: 周瑞
  • 基金资助:
    安徽省自然科学基金项目(2008085MH260)

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

Panpan Gu1,2, Chuanli ong2, Mengyao Song1, Sehua Qu1, Xiaodi Yang3, Rui Zhou1,()   

  1. 1.Department of Pediatrics,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,Anhui Province,China
    2.Department of Pediatrics,the Second Affiliated Hospital of Bengbu Medical University,Bengbu 233000,Anhui Province,China
    3.School of Basic Medicine,Bengbu Medical University,Bengbu 233030,Anhui Province,China
  • Received:2024-06-18 Revised:2024-07-17 Published:2024-08-01
  • Corresponding author: Rui Zhou
引用本文:

顾盼盼, 董传莉, 宋梦瑶, 瞿色华, 杨小迪, 周瑞. 不完全性川崎病患儿临床特征及冠状动脉损害情况分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 446-451.

Panpan Gu, Chuanli ong, Mengyao Song, Sehua Qu, Xiaodi Yang, Rui Zhou. Clinical characteristics and coronary artery lesions in children with incomplete Kawasaki disease[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 446-451.

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χ2 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(χ2=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.

Results

①The 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 (χ2 =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.

续表1
组别 例数 性别[例数(%)] 年龄[岁,MQ1Q3)] 发热时间[d,MQ1Q3)] 结膜充血[例数(%)] 口唇黏膜改变[例数(%)] 多形性皮疹[例数(%)]
IKD组 78 58(74.4) 20(25.6) 1.2(0.8,3.0) 8.0(6.8,10.0) 58(74.4) 50(64.1) 31(39.7)
CKD组 114 71(62.3) 43(37.7) 2.2(1.2,3.2) 7.0(5.0,7.2) 108(94.7) 102(89.5) 88(77.2)
统计量 χ2=3.06 Z=-3.39 Z=-4.64 χ2=16.43 χ2=18.08 χ2=27.56
P 0.080 0.001 <0.001 <0.001 <0.001 <0.001
组别 例数 四肢末端改变[例数(%)] 颈部淋巴结大[例数(%)] 卡疤红肿[例数(%)] PCT[ng/mL,MQ1Q3)] ESR(mm/h,xˉ±s CRP[mg/L,MQ1Q3)] WBC[×109/L,MQ1Q3)]
IKD组 78 25(32.1) 32(41.0) 17(21.8) 0.83(0.28,2.35) 61.6±24.7 80.0(49.0,112.9) 16.7(14.6,18.4)
CKD组 114 76(66.7) 83(72.8) 8(7.0) 0.61(0.25,1.39) 59.5±21.2 74.6(41.6,105.2) 15.9(12.4,18.1)
统计量 χ2=22.26 χ2=19.47 χ2=8.93 Z=-1.04 t=-0.66 Z=-0.86 Z=-1.72
P <0.001 <0.001 0.003 0.300 0.512 0.388 0.086
组别 例数 Neu%[%,MQ1Q3)] Hb[g/L,xˉ±s PLT(×109/L,xˉ±s ALT[U/L,MQ1Q3)] 白蛋白[g/L,xˉ±s CK-MB[U/L,MQ1Q3)]
IKD组 78 67.6(59.0,67.6) 107.8±9.8 521.6±136.4 25.0(17.0,88.0) 36.4±3.8 23.0(19.0,29.5)
CKD组 114 65.5(51.2,77.0) 112.1±9.6 494.1±124.0 18.5(14.0,55.2) 37.0±4.5 25.5(19.0,30.5)
统计量 Z=-0.93 t=3.00 t=-1.45 Z=-2.38 t=0.88 Z=-0.83
P值 0.353 0.003 0.148 0.017 0.383 0.409
表2 2组川崎病患儿被确诊时及随访6个月时超声心动图检查结果比较[例数(%)]
[1]
Kuo HC.Diagnosis,progress,and treatment update of Kawasaki disease[J].Int J Mol Sci,2023,24(18):13948.DOI:10.3390/ijms241813948.
[2]
吕爱婷, 何坤, 王芳洁, 等.2010年至2019年住院川崎病3 498例回顾性分析[J].医药论坛杂志,2023,44(3):9-12,16.DOI:1672-3422(2023)03-0009-05.Lyu AT,He K,Wang FJ,et al.A retrospective analysis of 3 498 hospitalized patients with Kawasaki disease from 2010 to 2019[J].J Med Forum,2023,44(3):9-12,16.DOI:1672-3422(2023)03-0009-05.
[3]
Bressieux-Degueldre S,Gradoux E,di Bernardo S,et al.Complete and incomplete Kawasaki disease:clinical differences and coronary artery outcome from a national prospective surveillance study in Switzerland[J].Front Pediatr,2023,11:1137841.DOI:10.3389/fped.2023.1137841.
[4]
Zhao QM,Huang M,Huang MR,et al.Characteristics and trends in diagnosis of Kawasaki disease outside the usual age range[J].Clin Rheumatol,2021,40(4):1515-1523.DOI:10.1007/s10067-020-05361-4.
[5]
中华医学会儿科学分会心血管学组, 中华医学会儿科学分会风湿学组, 中华医学会儿科学分会免疫学组, 等.川崎病诊断和急性期治疗专家共识[J].中华儿科杂志,2022,60(1):6-13.DOI:10.3760/cma.j.cn112140-20211018-00879.Cardiovascular Group of Pediatrics Branch of Chinese Medical Association,Rheumatology Section of Pediatrics Branch of Chinese Medical Association,Immunology Section of Pediatrics Branch of Chinese Medical Association,et al.The expert consensus on diagnosis and acute-phase treatment of Kawasaki disease[J].Chin J Pediatr,2022,60(1):6-13.DOI:10.3760/cma.j.cn112140-20211018-00879.
[6]
McCrindle BW,Rowley AH,Newburger JW,et al.Diagnosis,treatment,and long-term management of Kawasaki disease:a scientific statement for health professionals from the American Heart Association[J].Circulation,2017,135(17):e927-e999.DOI:10.1161/CIR.0000000000000484.
[7]
中华医学会儿科学分会心血管学组, 中华儿科杂志编辑委员会.川崎病冠状动脉病变的临床处理建议(2020年修订版)[J].中华儿科杂志,2020,58(9):718-724.DOI:10.3760/cma.j.cn112140-20200422-00421.Cardiovascular Group of Pediatrics Branch of Chinese Medical Association,Editorial Committee of ChineseJournal of Pediatrics.Recommendations for clinical management of Kawasaki disease with coronary artery lesions(2020 revision)[J].Chin J Pediatr,2020,58(9):718-724.DOI:10.3760/cma.j.cn112140-20200422-00421.
[8]
焦富勇, 穆志龙, 杜忠东, 等.儿童不完全性川崎病的诊治[J].中国当代儿科杂志,2023,25(3):238-243.DOI:10.7499/j.issn.1008-8830.2209127.Jiao FY,Mu ZL,Du ZD,et al.Diagnosis and treatment of incomplete Kawasaki disease in children[J].Chin J Contemp Pediatr,2023,25(3):238-243.DOI:10.7499/j.issn.1008-8830.2209127.
[9]
黄国英.川崎病诊断和治疗面临的挑战[J].中华儿科杂志,2022,60(1):3-5.DOI:10.3760/cma.j.cn112140-20211104-00927.Huang GY.Challenges in the diagnosis and treatment of Kawasaki disease[J].Chin J Pediatr,2022,60(1):3-5.DOI:10.3760/cma.j.cn112140-20211104-00927.
[10]
张伟, 王莉, 朱生东, 等.2014—2018年我院不完全川崎病诊断及临床特点分析[J].医学信息,2021,34(2):149-151.DOI:10.3969/j.issn.1006-1959.2021.02.041.Zhang W,Wang L,Zhu SD,et al.Analysis of incomplete Kawasaki disease diagnosis and clinical characteristics in our hospital from 2014 to 2018[J].J Med Inf,2021,34(2):149-151.DOI:10.3969/j.issn.1006-1959.2021.02.041.
[11]
王巧红.不完全川崎病的临床特征分析[J].中国当代医药,2023,30(6):88-91,95.DOI:10.3969/j.issn.1674-4721.2023.06.022.Wang QH.Analysis of clinical characteristics of incomplete Kawasaki disease[J].China Mod Med,2023,30(6):88-91,95.DOI:10.3969/j.issn.1674-4721.2023.06.022.
[12]
Roh DE,Kwon JE,Kim YH.Bacille Calmette-Guérin site reactivation of Kawasaki disease in infants under 3 months of age:relation with diagnosis and prognosis[J].Children(Basel),2022,9(6):857.DOI:10.3390/children9060857.
[13]
Hosseininasab A,Pashang F,Rukerd MRZ,et al.Kawasaki disease in children:a retrospective cross-sectional study[J].Reumatologia,2023,61(3):152-160.DOI:10.5114/reum/163170.
[14]
Huang YH,Kuo HC.Anemia in Kawasaki disease:hepcidin as a potential biomarker[J].Int J Mol Sci,2017,18(4):820.DOI:10.3390/ijms18040820.
[15]
Cao L,Tang YJ,Gang M,et al.AST-to-ALT ratio and coronary artery lesions among patients with Kawasaki disease[J].World J Pediatr,2021,17(6):659-668.DOI:10.1007/s12519-021-00479-0.
[16]
舒中宇, 邓芳, 杨舒馨影.川崎病合并肝功能损害的影响因素分析[J].中华全科医学,2023,21(4):622-625.DOI:10.16766/j.cnki.issn.1674-4152.002945.Shu ZY,Deng F,Yang SXY.Analysis of the influencing factors of Kawasaki disease combined with liver function impairment[J].Chin J Gen Pract,2023,21(4):622-625.DOI:10.16766/j.cnki.issn.1674-4152.002945.
[17]
Huang YN,Lin CY,Chi H,et al.Jaundice-predominant manifestation of Kawasaki disease in children[J].Front Pediatr,2023,11:1281909.DOI:10.3389/fped.2023.1281909.
[18]
Yang P,Mao Z,Sun M,et al.Clinical features analysis of Kawasaki disease with abdominal symptoms as the first manifestation[J].Eur J Pediatr,2023,182(9):4049-4057.DOI:10.1007/s00431-023-05086-x.
[19]
Davidson H,Kelly A,Agrawal R.Retrospective review of Kawasaki disease at the women's and children's hospital,South Australia[J].J Paediatr Child Health,2021,57(12):1893-1898.DOI:10.1111/jpc.15603.
[20]
Kolko N,Bhat YA,Al Mesned A,et al.Comparison of demographic,clinical,and echocardiographic features between complete and incomplete,and early and late presenters of Kawasaki disease:a 10-year single-center experience[J].Cureus,2023,15(9):e45819.DOI:10.7759/cureus.45819.
[21]
Mossberg M,Mohammad AJ,Kahn F,et al.High risk of coronary artery aneurysm in Kawasaki disease [J].Rheumatology (Oxford),2021,60(4):1910-1914.DOI:10.1093/rheumatology/keaa512.
[22]
Nomura Y,Yashiro M,Masuda K,et al.Treatment change and coronary artery abnormality in incomplete Kawasaki disease[J].Pediatr Int,2020,62(7):779-784.DOI:10.1111/ped.14242.
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