Neurological involvement in Kawasaki disease: a retrospective study
Neurological involvement in Kawasaki disease: a retrospective study
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川崎病的神经系统参与：一项回顾性研究
DOI：
10.1186/s12969-020-00452-7
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发表时间：
2020-07-14
影响因子：
2.5
通讯作者：
Wang, Chuan
中科院分区：
文献类型：
--
作者：
Liu, Xiaoliang;Zhou, Kaiyu;Wang, Chuan
研究背景川崎病（Kawasakidisease，KD）是一种急性、自限性系统性血管炎，好发于儿童。神经系统受累是KD的一种已知并发症，然而，其与KD严重程度的相关性仍然难以捉摸。我们的目的是系统地描述KD神经系统受累的一般表现，确定神经系统受累是否是KD患者疾病严重程度的标志物，并评估这种受累与静脉内免疫球蛋白（IVIG）抵抗和冠状动脉病变（CALs）的关系。将有神经系统症状的患者（A组，n= 80）与性别和入院日期匹配的无神经系统受累的患者（B组，n= 512）进行比较。进行多因素Logistic回归分析，以确定是否神经系统受累与IVIG resistance.Results5.1%（80/1582）的KD患者观察到神经系统受累。神经系统表现为弥漫性头痛（13/80，16.3%），惊厥（14/80，17.5%），嗜睡（40/80，50.1%），极度易怒脑膜刺激征（15/80，18.8%）、膨出（7/80，8.8%）和面瘫（1/80，1.3%）。47.5%（38/80）的患儿以神经系统症状为首发和/或主要表现。A组IVIG抵抗发生率及炎性标志物水平均高于B组。然而，神经系统受累不是IVIG抵抗或CALs.ConclusionRates的神经系统受累的独立危险因素是相对较低的KD患者。神经系统受累与IVIG抵抗和严重炎症负荷的风险增加相关。我们的研究结果强调了儿科医生需要认识到KD伴神经系统受累和标准IVIG治疗的重要性。
BackgroundKawasaki disease (KD) is an acute, self-limiting systemic vasculitis that predominately affects children. Neurological involvement is a known complication of KD, however, its association with KD severity remains elusive. We aimed to systematically describe the general manifestations of neurological involvement in KD, determine whether neurological involvement is a marker of disease severity in patients with KD, and assess the relationship of such involvement with intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs).MethodsWe retrospectively reviewed data from 1582 patients with KD between January 2013 and December 2017. Profiles of patients with neurological symptoms (group A,n= 80) were compared to those of gender- and admission date-matched patients without neurological involvement (group B,n= 512). Multivariate logistic regression analyses were performed to determine whether neurological involvement was significantly associated with IVIG resistance.ResultsNeurological involvement was observed in 5.1% (80/1582) of patients with KD. The neurological manifestations were diffuse, presenting as headache (13/80, 16.3%), convulsions (14/80, 17.5%), somnolence (40/80, 50.1%), extreme irritability (21/80, 26.3%), signs of meningeal irritation (15/80, 18.8%), bulging fontanelles (7/80, 8.8%), and facial palsy (1/80, 1.3%). Neurological symptoms represented the initial and/or predominant manifestation in 47.5% (38/80) of patients with KD. The incidence of IVIG resistance and levels of inflammatory markers were higher in group A than in group B. However, neurological involvement was not an independent risk factor for IVIG resistance or CALs.ConclusionRates of neurological involvement were relatively low in patients with KD. Neurological involvement was associated with an increased risk of IVIG resistance and severe inflammatory burden. Our results highlight the need for pediatricians to recognize KD with neurological involvement and the importance of standard IVIG therapy.Trial registrationRetrospectively registered.