Characteristics and Indications of Kawasaki Disease Among Infants Under 6 Months
Characteristics and Indications of Kawasaki Disease Among Infants Under 6 Months
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6个月以下婴儿川崎病的特点和适应症
DOI：
10.3389/fped.2020.00470
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发表时间：
2020
影响因子：
2.6
通讯作者：
Lv Haitao
中科院分区：
文献类型：
--
作者：
Tang Yunjia;Li Xuan;Cao Lei;Chen Ye;Yan Wenhua;Xu Qiuqin;Lv Haitao
目的：探讨6个月以内川崎（KD）的发病特点及不完全性KD（iKD）的可能指征。研究方法：对2007年1月至2017年12月在苏州大学附属儿童医院住院的KD患者的病历进行回顾性分析。选择年龄、性别相匹配的以高热为主诉的6个月以下尿路感染（UTI）和腺病毒（ADV）感染患者各50例作为对照组。结果：共纳入1，872例KD患者。其中6个月以下婴儿患者194例（10.4%）。6个月以下患儿iKD为72例（37.1%），6个月以上患儿iKD为494例（29.4%）（P < 0.05）。虽然6个月以下的患者在免疫球蛋白（IVIG）治疗前的发热持续时间较短，但这些患者中有较大比例的IVIG抵抗和冠状动脉病变。他们还往往有较高的血小板（PLT）计数和C反应蛋白（CRP）和较低的血红蛋白（Hb），中性粒细胞百分比（N%），白蛋白和血清钠。6个月以下iKD与UTI、ADV感染组比较，白色细胞（WBC）、Hb、PLT、CRP、N%、血清白蛋白差异有统计学意义（P < 0.05）。调整混杂因素后，与ADV感染相比，Hb < 105.5 g/L、CRP > 22.7 mg/L、N% > 47.4和PLT > 496 × 109/L是iKD的指征（曲线下面积[AUC]分别为0.872、0.939、0.707和0.684）。与UTI相比，N% > 51.8和白蛋白< 39.0 g/L是iKD的指征（AUC分别为0.627和0.832）。结论：6个月以内的KD患儿有其特殊性。与UTI和ADV感染相比，实验室变量可能是iKD的良好指征。
Objectives: To explore the characteristics of Kawasaki disease (KD) under 6 months and to investigate the possible indications of incomplete KD (iKD). Methods: The medical records of KD patients hospitalized in Children's Hospital of Soochow University from January 2007 to December 2017 were retrospectively reviewed and analyzed. A total of 50 cases of urinary tract infection (UTI) and 50 cases of adenovirus (ADV)-infected patients under 6 months that were age and gender-matched with the main complaint of high fever were selected as controls. Results: A total of 1,872 KD patients were enrolled. Among them, 194 (10.4%) were infantile patients under 6 months. There were 72 (37.1%) and 494 (29.4%) iKD in patients younger and older than 6 months, respectively (P < 0.05). Although patients under 6 months had a shorter fever duration before immunoglobulin (IVIG) treatment, a larger proportion of these patients had IVIG resistance and coronary artery lesions. They also tended to have higher platelet (PLT) counts and C-reactive protein (CRP) and lower hemoglobin (Hb), percentage of neutrophils (N%), albumin and serum sodium. When we compared iKD under 6 months with UTI and ADV-infected patients, significant differences were found in white blood cells (WBC), Hb, PLT, CRP, N% and serum albumin (P < 0.05). After adjusting the confounders, Hb < 105.5 g/L, CRP > 22.7 mg/L, N% > 47.4 and PLT > 496 × 109/L were indications of iKD when compared with ADV infection (area under the curve [AUC]: 0.872, 0.939, 0.707, and 0.684, respectively). N% > 51.8 and albumin < 39.0 g/L were indications of iKD when compared with UTI (AUC: 0.627 and 0.832, respectively). Conclusions: Infantile KD patients under 6 months had their own particularity. Laboratory variables could be good indications of iKD when compared with UTI and ADV infection.