Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan
Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan
复制标题
日本近畿地区川崎病的治疗现状和结果
DOI：
10.1111/ped.15391
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Suzuki H; steering committee of the Society of Kinki Area Kawasaki Disease Research.
中科院分区：
文献类型：
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作者：
Tsuchihashi T;Kakimoto N;Kitano N;Suenaga T;Ikeda K;Izui M;Kobayashi N;Yoshimura K;Nakamura Y;Suzuki H; steering committee of the Society of Kinki Area Kawasaki Disease Research.
研究背景急性川崎的治疗指南经过多次修订。此外，用于定义冠状动脉异常（CAA）的标准已从冠状动脉内径变为Z评分。KD的治疗和评估CAA的方法因医院而异，因此我们根据2012年日本急性KD治疗指南调查了急性KD治疗的实际状况和CAA的发展。MethodsThe 24th Japanese Nationwide Survey on川崎Disease在2016年在Kinki地区发现了2618例KD患者。我们向每家参与医院发送了二次问卷，并使用所得数据根据Z评分、KD治疗阶段的治疗和CAAs的预测因素调查CAAs的频率。对1426例无重大数据缺陷的患者的数据进行了检查。基于冠状动脉内径的CAA发生率为3.0%，基于Z评分的CAA发生率为8.8%。12.8%的病例将静脉注射免疫球蛋白联合皮质类固醇作为初始治疗，16.8%的病例将其作为二线治疗。皮质类固醇、环孢素A、英夫利西单抗和血浆置换以相似的频率用于三线治疗。治疗前最大冠状动脉Z评分≥1.9和年龄<1岁与CAAs.ConclusionsUsing theZ评分导致确诊为CAAs的患者数量增加了3倍。治疗前最大冠状动脉Z评分≥1.9和年龄<1岁是CAA的有用预测因素。
BackgroundThe treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to theZ‐score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD.MethodsThe 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according toZ‐score, treatment by KD treatment stage, and predictors of CAAs.ResultsThe response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based onZ‐scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second‐line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third‐line treatment. A pretreatment maximum coronary arteryZ‐score of ≥1.9 and age <1 year were associated with significantly higher incidences of CAAs.ConclusionsUsing theZ‐score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary arteryZ‐score of ≥1.9 and age <1 year are useful predictors of CAAs.