Predictive risk factors for coronary artery abnormalities in Kawasaki disease
Predictive risk factors for coronary artery abnormalities in Kawasaki disease
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DOI：
10.1007/s00431-006-0251-8
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发表时间：
2007-05-01
影响因子：
3.6
通讯作者：
Lee, JooWon
中科院分区：
文献类型：
--
作者：
Kim, TaeYeun;Choi, WookSun;Lee, JooWon
通过回顾2001年3月至2005年2月在韩国大学医学中心诊断为川崎病（KD）的患者的病历，评估了预测KD冠状动脉异常（CAA）发展的临床特征。在285例诊断为KD的患者中，19例发生CAA（6.7%）。与CAA（-）组相比，CAA（+）组静脉注射丙种球蛋白（IVGG）后发热持续时间更长（2.4 +/- 2.9 vs. 1.5 +/- 1.2天，p=0.008），C反应蛋白（CRP）更高（12.3 +/- 7.8 vs. 8.7 +/- 7.1 mg/dL p=0.038）。尤其是CAA（+）组在IVGG前发热超过7天，IVGG后发热超过3天（26.3 vs. 5.3%，p < 0.001; 26.3 vs. 6.4%，p=0.002）。当IVGG反应性定义为IVGG后3天内出现退热时，IVGG无反应者显示CAA发生率较高（22.7% vs. 5.3%，p=0.002）。无反应者IVGG后发热持续时间较长（5.5 +/- 1.9 vs. 1.2 +/- 0.6天，p < 0.001），CRP、AST、ALT和总胆红素显著升高。多因素回归分析显示，持续时间超过8d的总发热是CAA发生的唯一危险因素（OR=4.052，95%CI =1.151- 14.263，p =0.0293）。总的来说，KD中CAA最重要的预测因素是总发热时间超过8天。早期发现IVGG无应答者，积极治疗KD发热可降低CAA的发生率。
Clinical characteristics to predict the development of coronary artery abnormalities (CAA) in Kawasaki disease (KD) were assessed by reviewing medical records of patients diagnosed with KD at Korea University Medical Center from March 2001 to February 2005. Of the 285 patients diagnosed with KD, 19 developed CAA (6.7%). Compared with the CAA(-) group, the CAA(+) group had a longer duration of fever after intravenous gamma-globulin (IVGG) injection (2.4 +/- 2.9 vs. 1.5 +/- 1.2 days, p=0.008) and higher C-reactive protein (CRP)(12.3 +/- 7.8 vs. 8.7 +/- 7.1 mg/dL p=0.038). In particular, the CAA(+) group tended to have more than 7 days of fever before IVGG and more than 3 days of fever after IVGG (26.3 vs. 5.3%, p < 0.001; 26.3 vs. 6.4%, p=0.002). When the IVGG responsiveness was defined by the presence of defervescence within 3 days after IVGG, IVGG-non-responders showed a higher incidence of CAA (22.7 vs. 5.3%, p=0.002). Non-responders had a longer duration of fever after IVGG (5.5 +/- 1.9 vs. 1.2 +/- 0.6 days, p < 0.001) and a significantly increased CRP, AST, ALT and total bilirubin. Multivariate regression analysis for CAA showed that the only factor significantly associated with the development of CAA was total fever that lasted for longer than 8 days (OR=4.052, 95% CI=1.151-14.263,p=0.0293). Conclusively, the most important predictor of CAA in KD is total duration of fever longer than 8 days. Early identification of IVGG non-responders and active therapeutic intervention for fever in KD cases might decrease the incidence of CAA.