Clinical feature analysis of recurrent Kawasaki disease in children and literature review

doi:10.3877/cma.j.issn.1673-5250.2021.01.010

Objective

To explore the incidence, clinical features and coronary artery lesion (CAL) of recurrent Kawasaki disease.

Methods

From May 2010 to October 2019, a total of 10 children with recurrent Kawasaki disease who admitted to the Heart Center of Qingdao Women and Children′s Hospital were selected as research subjects. Their clinical data were analyzed retrospectively, and comparison with whose initial Kawasaki disease of clinical manifestations and laboratory examination results were conducted by paired t-test, Fisher′s exact probability method and Wilcoxon signed rank sum test. The literatures about children with recurrent Kawasaki disease at home and abroad were reviewed. This study was approved by the Ethics Committee of Qingdao Women and Children′s Hospital (Approval No. QFELL-KY-2019-64).

Results

①From January 2010 to December 2019, the recurrence rate of Kawasaki disease was 1.16% (10/865), among of recurrent Kawasaki disease children, there were 7 males and 3 females. ②The age of 10 children with recurrent Kawasaki disease was (42.0±15.8) months at the time of recurrence, and the interval between the initial onset and recurrence was (12.1±6.2) months. They were followed up from discarge to April 2020, and the prognosis was good. ③Comparison of related indicators: there were no significant differences between 10 children with recurrent Kawasaki disease at the time of initial onset and recurrence in duration of fever, incidence of rash, lymphadenectasis, bulbar conjunctiva hyperremia, lip congestion and scleroma of hands and feet, serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), albumin, alanine transaminase (ALT) and aspartate aminotransferase (AST), and white blood cell count and platelet count (all P>0.05). Also incidence of CAL (P>0.05). ④Results of literature review: recurrence rate of Kawasaki disease was 1.3%-3.4%, male children were more common, the age of initial onset was 0.4-2.2 years, interval from initial onset to recurrence was 1.0-3.3 years, fever duration of recurrence was shorter than that of initial onset, incidence of CAL of children with Kawasaki disease at the time of initiate and recurrent were 6.3%-45.5% and 6.3%-60.0%, respectively.

Conclusions

Recurrent Kawasaki disease was more common in children under 5 years old, and most of them occurred within 1.5 years after initial onset. The incidence of CAL of children with recurrent Kawasaki disease did not increase significantly compared to their initial onset. No clear risk factors related to recurrence of Kawasaki disease have been found yet. Children with Kawasaki disease in infancy may have a higher risk of recurrence.

Key words: Mucocutaneous lymph node syndrome, Recurrence, Clinical feature, Coronary artery lesion, Epidemiology, Child

表1 本组再发川崎病患儿初发与再发时临床资料比较

川崎病	例数	热程(d，±s)	皮疹[例数(%)]	淋巴结肿大[例数(%)]	球结膜充血[例数(%)]	口唇充血[例数(%)]	手足硬肿[例数(%)]	血清CRP水平(mg/L，±s)
初发	10	6.1±1.4	6(60.0)	7(70.0)	10(100.0)	8(80.0)	6(60.0)	65.6±39.1
再发	10	5.3±0.8	7(70.0)	8(80.0)	10(100.0)	8(80.0)	5(50.0)	47.2±28.5
检验值		t＝1.350	-^a	-^a	-^a	-^a	-^a	t＝1.099
P值		0.210	0.330	0.350	1.000	0.420	0.320	0.300
川崎病	例数	血清ESR水平(mm/h，±s)	Hb水平(g/L，±s)	白细胞计数(×10⁹/L, ±s)	血小板计数(×10⁹/L, ±s)	血清白蛋白水平(g/L，±s)	血清ALT水平[U/L，M(P₂₅～P₇₅)]	血清AST水平[U/L，M(P₂₅～P₇₅)]
初发	10	50.4±26.8	106.8±10.1	17.9±10.2	412.9±120.8	40.4±4.6	30.7(18.7～67.0)	44.7(27.7～53.2)
再发	10	39.3±11.7	103.0±6.6	16.3±4.4	445.5±156.8	37.9±4.6	23.2(18.1～25.1)	30.7(18.1～25.1)
检验值		t＝1.116	t＝1.633	t＝0.470	t＝-0.456	t＝1.049	Z＝-0.454	Z＝0.000
P值		0.293	0.137	0.650	0.659	0.321	0.650	1.000

表1 本组再发川崎病患儿初发与再发时临床资料比较

川崎病	例数	热程(d，±s)	皮疹[例数(%)]	淋巴结肿大[例数(%)]	球结膜充血[例数(%)]	口唇充血[例数(%)]	手足硬肿[例数(%)]	血清CRP水平(mg/L，±s)
初发	10	6.1±1.4	6(60.0)	7(70.0)	10(100.0)	8(80.0)	6(60.0)	65.6±39.1
再发	10	5.3±0.8	7(70.0)	8(80.0)	10(100.0)	8(80.0)	5(50.0)	47.2±28.5
检验值		t＝1.350	-^a	-^a	-^a	-^a	-^a	t＝1.099
P值		0.210	0.330	0.350	1.000	0.420	0.320	0.300
川崎病	例数	血清ESR水平(mm/h，±s)	Hb水平(g/L，±s)	白细胞计数(×10⁹/L, ±s)	血小板计数(×10⁹/L, ±s)	血清白蛋白水平(g/L，±s)	血清ALT水平[U/L，M(P₂₅～P₇₅)]	血清AST水平[U/L，M(P₂₅～P₇₅)]
初发	10	50.4±26.8	106.8±10.1	17.9±10.2	412.9±120.8	40.4±4.6	30.7(18.7～67.0)	44.7(27.7～53.2)
再发	10	39.3±11.7	103.0±6.6	16.3±4.4	445.5±156.8	37.9±4.6	23.2(18.1～25.1)	30.7(18.1～25.1)
检验值		t＝1.116	t＝1.633	t＝0.470	t＝-0.456	t＝1.049	Z＝-0.454	Z＝0.000
P值		0.293	0.137	0.650	0.659	0.321	0.650	1.000

表2 儿童再发川崎病相关文献分析

文献(第1作者，文献发表年)	川崎病再发率[%(n/n′)]	男∶女	初发年龄[岁，M(P₂₅～P₇₅)或±s]	距再发的间隔时间[年，M(P₂₅～P₇₅)或±s]	初发时热程[d，±s或M(P₂₅～P₇₅)]	再发时热程(d，±s或M(P₂₅～P₇₅)]	初发时CAL发生率[例数(%)]	再发时CAL发生率[例数(%)]
王宏伟^[5]，2002	3.1(10/322)	7∶3	1.4	1.6	12.1±2.4	9.4±3.0	3(30.0)	6(60.0)
孔东明^[6]，2012	1.8(22/1 253)	19∶3	1.7(0.3～4.5)	1.0(0.2～2.5)	10.1±3.1	8.0±2.3	8(36.4)	7(31.8)
姚晓利^[7]，2013	1.6(77/4 875)	45∶32	2.1(0.2～6.6)	1.6(0.2～7.0)	8.9±3.9	7.6±3.1	13(17.8)	10(13.3)
刘仕成^[8]，2010	3.4(13/387)	7∶6	1.4±1.0	1.4±0.6	7.4±1.9	5.0±0.5	2(15.4)	1(7.7)
邹丽霞^[9]，2008	1.3(20/1 489)	12∶8	0.4(0.1～5.5)	1.2(0.2～4.6)	10.1±3.4	7.0±2.4	5(25.0)	8(40.0)
王珍全^[10]，2014	1.5(17/1 139)	11∶6	1.6±1.3	2.1±1.3	8.6±1.8	10.8±3.3	2(11.8)	9(52.9)
Yang^[14]，2013	1.7(22/1 152)	9∶13	2.2±1.4	3.3±1.6	8.1±3.1	8.5±5.3	10(45.5)	8(36.3)
Chahal^[15]，2012	1.6(16/1 010)	10∶6	2.2(0.2～15.7)	1.5	7(5～23)	6(3～10)	1(6.3)	1(6.3)

表2 儿童再发川崎病相关文献分析

文献(第1作者，文献发表年)	川崎病再发率[%(n/n′)]	男∶女	初发年龄[岁，M(P₂₅～P₇₅)或±s]	距再发的间隔时间[年，M(P₂₅～P₇₅)或±s]	初发时热程[d，±s或M(P₂₅～P₇₅)]	再发时热程(d，±s或M(P₂₅～P₇₅)]	初发时CAL发生率[例数(%)]	再发时CAL发生率[例数(%)]
王宏伟^[5]，2002	3.1(10/322)	7∶3	1.4	1.6	12.1±2.4	9.4±3.0	3(30.0)	6(60.0)
孔东明^[6]，2012	1.8(22/1 253)	19∶3	1.7(0.3～4.5)	1.0(0.2～2.5)	10.1±3.1	8.0±2.3	8(36.4)	7(31.8)
姚晓利^[7]，2013	1.6(77/4 875)	45∶32	2.1(0.2～6.6)	1.6(0.2～7.0)	8.9±3.9	7.6±3.1	13(17.8)	10(13.3)
刘仕成^[8]，2010	3.4(13/387)	7∶6	1.4±1.0	1.4±0.6	7.4±1.9	5.0±0.5	2(15.4)	1(7.7)
邹丽霞^[9]，2008	1.3(20/1 489)	12∶8	0.4(0.1～5.5)	1.2(0.2～4.6)	10.1±3.4	7.0±2.4	5(25.0)	8(40.0)
王珍全^[10]，2014	1.5(17/1 139)	11∶6	1.6±1.3	2.1±1.3	8.6±1.8	10.8±3.3	2(11.8)	9(52.9)
Yang^[14]，2013	1.7(22/1 152)	9∶13	2.2±1.4	3.3±1.6	8.1±3.1	8.5±5.3	10(45.5)	8(36.3)
Chahal^[15]，2012	1.6(16/1 010)	10∶6	2.2(0.2～15.7)	1.5	7(5～23)	6(3～10)	1(6.3)	1(6.3)

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