川崎病合并冠状动脉瘤危险因素分析

doi:10.12372/jcp.2023.23e0285

摘要/Abstract

摘要：

目的探讨川崎病（KD）发生冠状动脉瘤（CAA）的危险因素。方法回顾性分析2020年1月至2021年12月住院确诊KD患儿的临床资料。根据有无CAA将患儿分为CAA组和非CAA组，比较两组间临床特征，分析影响CAA发生的危险因素和相关指标及预测KD并发CAA的价值。结果纳入KD患儿557例，男346例、女211例，中位发病年龄25.0（13.0~45.2）月，并发CAA 75例（13.5%），IVIG无应答型KD 39例（7.0%）。多因素logistic回归分析结果提示，年龄≤1岁、静脉注射丙种球蛋白（IVIG）无反应、血小板计数（PLT）升高是影响KD并发CAA的独立危险因素，白蛋白（ALB）升高是影响KD并发CAA的保护因素（P<0.05）。ROC曲线分析发现，PLT和ALB预测KD并发CAA的曲线下面积（AUC）分别为0.64（0.57~0.73）和0.65（0.58~0.72）。当PLT>551×10⁹/L时，其预测KD并发CAA的灵敏度为63.0%，特异度为67.0%；当ALB<36.5 U/L时，其预测KD并发CAA的灵敏度为68.0%，特异度为56.0%。结论年龄≤1岁、IVIG无反应、PLT>551×10⁹/L、ALB<36.5 U/L对KD患儿发生CAA有一定的预测作用。

关键词: 川崎病, 冠状动脉瘤, 高危因素

Abstract:

Objective To investigate the risk factors of coronary artery aneurysm (CAA) occurrence in children with Kawasaki disease (KD). Methods The clinical data of children with KD hospitalized from January 2020 to December 2021 were retrospectively analyzed. According to the presence or absence of CAA, the children were divided into CAA group and non-CAA group, and the clinical characteristics between the two groups were compared. The risk factors affecting the occurrence of CAA and the predictive value of related indicators for KD complicated with CAA were analyzed. Results A total of 557 children with KD (346 boys and 211 girls) were included, and the median age was 25.0 (13.0-45.2) months. CAA was found in 75 patients (13.5%) and intravenous immunoglobulin (IVIG) resistance was observed in 39 (7.0%) patients. Multivariate logistic regression analysis showed that age ≤1 year, IVIG resistance and elevated platelet count (PLT) were independent risk factors for KD complicated with CAA, and elevated albumin (ALB) was a protective factor for KD complicated with CAA (P<0.05). ROC curve analysis showed that the area under ROC curve (AUC) of PLT and ALB predicting KD with CAA was 0.64 (0.57-0.73) and 0.65 (0.58-0.72), respectively. The sensitivity and specificity of PLT>551×10⁹/L for predicting KD with CAA were 63.0% and 67.0%, and the sensitivity and specificity of ALB<36.5U/L for predicting KD with CAA were 68.0% and 56.0%. Conclusions Age≤1 year, IVIG resistance, PLT>551×10⁹/L and ALB<36.5U/L had certain predictive effects on the occurrence of CAA in children with Kawasaki disease.

Key words: Kawasaki disease, coronary artery aneurysm, risk factor

周翠臻, 宋思瑞, 陈丽琴, 黄敏. 川崎病合并冠状动脉瘤危险因素分析[J]. 临床儿科杂志, 2023, 41(7): 498-501.

ZHOU Cuizhen, SONG Sirui, CHEN Liqin, HUANG Min. Risk factors analysis of coronary artery aneurysm occurrence in children with Kawasaki disease[J]. Journal of Clinical Pediatrics, 2023, 41(7): 498-501.

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项目	CAA组(n=75)	非CAA组(n=482)	统计量	P
年龄[n(%)]			χ²=11.86	0.003
≤1岁	29(38.7)	101(20.9)
~5岁	37(49.3)	323(67.1)
~18岁	9(12.0)	58(12.0)
男性[n(%)]	53(70.7)	293(60.8)	χ²=2.69	0.101
热程[M(P₂₅~P₇₅)]/d	7.0(5.0~8.0)	6.0(6.0~8.0)	Z=1.02	0.304
IVIG使用时间[M(P₂₅~P₇₅)]/d	6.0(5.0~7.0)	6.0(5.0~7.0)	Z=1.53	0.127
IVIG无反应[n(%)]	14(18.7)	25(5.2)	χ²=18.11	<0.001
WBC[M(P₂₅~P₇₅)]/×10⁹·L^-1	17.7(14.8~20.2)	16.6(13.8~20.2)	Z=0.45	0.648
HB(x±s)/g·L^-1	95.6±13.4	100.3±11.1	t=3.29	0.001
PLT[M(P₂₅~P₇₅)]/×10⁹·L^-1	576.0(460.0~705.0)	483.0(402.7~589.2)	Z=3.92	<0.001
CRP[M(P₂₅~P₇₅)]/mg·L^-1	86.0(42.0~128.0)	68.0(42.0~96.0)	Z=2.48	0.013
ESR[M(P₂₅~P₇₅)]/mm·h^-1	97.0(66.5~120.0)	86.0(61.0~112.0)	Z=1.53	0.125
ALT[M(P₂₅~P₇₅)]/U·L^-1	20.0(13.1~61.6)	23.7(13.3~55.2)	Z=0.44	0.659
ALB(x±s)/g·L^-1	34.9±3.9	37.1±5.0	t=3.95	<0.001
Na(x±s)/mmol·L^-1	134.6±3.6	134.7±7.1	t=0.04	0.967
D-D[M(P₂₅~P₇₅)]/mg·L^-1	1.0(0.6~1.97)	1.1(0.7~1.9)	Z=1.59	0.431
FDP[M(P₂₅~P₇₅)]/μg·mL^-1	5.7(2.9~9.9)	6.5(4.2~10.5)	Z=1.59	0.112
NT-BNP[M(P₂₅~P₇₅)]/pg·mL^-1	543.0(165.0~1 693.0)	283.5(109.5~747.5)	Z=2.53	0.011

项目	偏回归系数	标准误	χ²值	OR(95% CI)	P
年龄≤1岁	0.95	0.40	5.65	2.60(1.18~5.73)	0.017
IVIG无反应	1.48	0.48	9.27	4.40(1.69~11.42)	0.002
HB	0.20	0.01	2.39	1.02(0.99~1.04)	0.122
CRP	0.00	0.00	0.12	1.00(0.99~1.01)	0.720
PLT	0.00	0.00	6.51	1.02(1.01~1.05)	0.011
ALB	-0.08	0.04	4.05	0.91(0.84~0.97)	0.025
NT-BNP	0.00	0.00	0.64	1.00(1.00~1.00)	0.424
常量	-2.98	2.08	2.04	-	0.153