Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease
Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease
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DOI：
10.1136/archdischild-2018-314967
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发表时间：
2019-05-01
影响因子：
5.2
通讯作者：
Rowley, Anne H.
中科院分区：
文献类型：
--
作者：
Cameron, Scott A.;Carr, Michael;Rowley, Anne H.
目的比较婴幼儿和年龄较大的川崎病患儿冠状动脉病变的严重程度。方法回顾和比较本中心10年来1岁川崎病患儿和1岁川崎病患儿的冠状动脉扩张和动脉瘤严重程度，并与1岁川崎病患儿进行比较。结果在研究期间确认的93名婴儿中，80名在患病前10天内接受了静脉注射丙种球蛋白治疗，并与来自儿科心脏网络公共数据库的170名在相同时间段内接受治疗的1岁儿童进行比较。婴儿的平均最大z分数显著高于年龄较大的儿童(3.37vs2.07，p=1岁)(中型动脉瘤为11%vs3%，p=0.015；巨大动脉瘤为8%vs1%，p=0.005)。结论婴幼儿川崎病患者冠状动脉扩张较大年龄儿童严重，中大型动脉瘤的患病率较高。由于不良结局与川崎病的冠状动脉最大直径密切相关，因此被诊断为婴儿的患者需要对心脏并发症进行非常密切的长期监测。
Objective We aimed to compare the severity of coronary artery abnormalities in Kawasaki disease between infants and older children.Methods We retrospectively reviewed and compared coronary artery dilation and aneurysm severity in infants < 1 year of age with Kawasaki disease at our centre over a 10-year period with that observed in children >= 1 year of age in the Pediatric Heart Network Trial of Pulse Steroid Therapy in Kawasaki Disease. Coronary artery abnormalities were defined by z-scores according to American Heart Association guidelines.Results Of the 93 infants identified during the study period, 80 were treated with intravenous gamma globulin within the first 10 days of illness and were included for comparison to 170 children >= 1 year of age treated in the same time frame from the Pediatric Heart Network public database. The mean maximum z-score was significantly higher in infants compared with older children (3.37 vs 2.07, p= 1 year of age (11% vs 3% for medium aneurysms, p=0.015; 8% vs < 1% for giant aneurysms, p=0.005).Conclusions Infants with Kawasaki disease have more severe coronary artery dilation compared with older children, and a higher prevalence of medium and giant aneurysms. Because adverse outcomes are closely linked to the maximal coronary artery diameter in Kawasaki disease, patients diagnosed as infants require very close long-term monitoring for cardiac complications.