Analysis of risk factors and prospective evaluation of cardiovascular complications of Kawasaki disease in children: a single centre study
Analysis of risk factors and prospective evaluation of cardiovascular complications of Kawasaki disease in children: a single centre study
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DOI：
10.5603/kp.a2013.0180
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发表时间：
2013-01-01
影响因子：
3.3
通讯作者：
Malecka-Tendera, Ewa
中科院分区：
文献类型：
--
作者：
Berdej-Szczot, Elzbieta;Firek-Pedras, Malgorzata;Malecka-Tendera, Ewa
背景：川崎病（KD）由于临床症状不特异，诊断困难。延迟治疗会增加冠状动脉并发症的风险。目的：为了评估冠状动脉受累的风险，并进行前瞻性分析，其过程中住院的儿童KD.Methods：KD被诊断为38名儿童，其中包括25名男孩和13名女孩，年龄1.5-118个月（中位数37.5个月）。我们评估了心脏并发症的风险与疾病的完整或不完整形式、年龄、性别和实验室检查结果以及治疗开始的时间有关。36例患儿随访1-9年。结果：80%以上的川崎病患儿年龄小于5岁。其中11人（29%）患有不完全形式的疾病。10例（26%）患儿出现冠状动脉异常，不完全KD患儿的冠状动脉异常率更高。每延迟一天治疗，并发症发生率增加近1.5（OR 1.45，p = 0.009）。在发病后10天开始治疗，这种风险增加了近9倍（OR 8.99，p = 0.007）。在有和无冠状动脉并发症的组之间，年龄（p = 0.431）、性别（p = 0.744）和实验室检查结果无显著差异。7例患儿冠状动脉受累完全消退，1例患儿部分消退。一名儿童死亡，另一个需要冠状动脉旁路移植术。结论：冠状动脉瘤的发展在两个完全和不完全的形式KD和唯一的显着的危险因素是治疗开始的时间以相似的速度。对于不明原因发热超过5天的幼儿，超声心动图检查是必要的。尽管冠状动脉瘤有消退的趋势，但可能发生晚期并发症，所有儿童都需要在心脏病诊所进行长期随访。
Background: Kawasaki disease (KD) remains a diagnostic challenge due to its nonspecific clinical symptoms. Delayed treatment initiation increases the risk of coronary complications. Aim: To evaluate the risk of coronary artery involvement and perform a prospective analysis of its course in children hospitalised due to KD.Methods: KD was diagnosed in 38 children, including 25 boys and 13 girls, aged 1.5-118 months (median 37.5 months). We assessed the risk of cardiac complications in relation to the presence of a complete or incomplete form of the disease, age, gender and laboratory test results, as well as the timing of treatment initiation. Thirty-six children were followed for 1-9 years in a cardiology clinic.Results: More than 80% of patients with KD were younger than 5 years. Eleven (29%) of them had an incomplete form of the disease. Coronary artery abnormalities were found in 10 (26%) children, insignificantly more often among those with incomplete KD. Each day of treatment delay increased the complication rate by almost 1.5 (OR 1.45, p = 0.009). Treatment initiated 10 days after the onset of the disease increased this risk almost nine times (OR 8.99, p = 0.007). No significant differences in respect to age (p = 0.431), gender (p = 0.744) and laboratory test results were found between the groups with and without coronary complications. A complete regression of coronary artery involvement was seen in 7 children, and partial regression was seen in one child. One child died and another needed coronary artery bypass grafting.Conclusions: Coronary artery aneurysms developed at a similar rate in both complete and incomplete forms of KD and the only significant risk factor was the timing of treatment initiation. In young children with fever of unknown cause lasting longer than 5 days, echocardiography is warranted. Despite a tendency for coronary artery aneurysms to regress, late complications may occur and all children require long-term follow up in a cardiology clinic.