Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age
Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age
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DOI：
10.1007/s00431-009-0925-0
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发表时间：
2009-11-01
影响因子：
3.6
通讯作者：
Lee, JooWon
中科院分区：
文献类型：
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作者：
Song, DooIl;Yeo, Yunku;Lee, JooWon
川崎（KD）的临床表现和发生冠状动脉异常（CAA）的危险因素可能因年龄而异。从2001年1月至2007年7月，161例年龄小于1岁的患者（年轻组）和60例年龄大于5岁的患者（老年组）在高丽大学医学中心被诊断为KD。回顾性审查了他们的病历，并比较了两组通常与CAA发生相关的多个变量，包括临床表现和实验室检查结果。虽然我院KD相关CAA的总体发生率为6.7%，但年轻组有20例（12.4%）发生CAA，老年组有10例（16.7%）。与CAA（-）病例相比，年轻组CAA（+）病例的总发热持续时间更长（9.1 +/- 3.3 vs 6.3 +/- 1.9天，p = 0.002），诊断症状更少（3.0 +/- 1.2 vs 4.3 +/- 1.1，p < 0.001）。老年组CAA（+）患者总热持续时间较长（14.1 +/- 10.4 vs 6.5 +/- 1.9天，p = 0.045），尤其是静脉注射丙种球蛋白（IVGG）后发热（7.9 +/- 9.6 vs 1.1 +/- 0.8天，p = 0.052），总白色血细胞计数、红细胞沉降率、C反应蛋白水平、总胆红素水平和Harada评分高于CAA（-）病例，血清白蛋白和钠水平低于CAA（-）病例。多因素Logistic回归分析显示，与CAA发生显著相关的因素为总症状数（OR = 0.494，95%置信区间（CI）= 0.281-0.871，p = 0.015）和IVGG后发热持续时间（OR = 1.958，95%CI = 1.098-3.492，p = 0.023）和Harada评分（OR = 3.455，95%CI = 1.012 ~ 11.796，年轻组的不完全临床表现和老年组的IVGG无反应性与KD的发生相关。相关CAA这些年龄特异性特征可以帮助定制KD的诊断和治疗策略，从而有助于改善这种疾病的结果。
The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age.From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings.While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1 +/- 3.3 vs 6.3 +/- 1.9 days, p = 0.002) and showed fewer diagnostic symptoms (3.0 +/- 1.2 vs 4.3 +/- 1.1, p < 0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1 +/- 10.4 vs 6.5 +/- 1.9 days, p = 0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9 +/- 9.6 vs 1.1 +/- 0.8 days, p = 0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR = 0.494, 95% confidence interval (CI) = 0.281-0.871, p = 0.015) in the younger group and the duration of post-IVGG fever (OR = 1.958, 95% CI = 1.098-3.492, p = 0.023) and the Harada score (OR = 3.455, 95% CI = 1.012-11.796, p = 0.048) in the older group.Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.