川崎病延迟治疗冠状动脉损害相关危险因素分析

摘要

目的:探讨不同状态下川崎病延迟治疗患儿冠状动脉损害相关危险因素.方法:收集2009年1月至2014年12月在温州医科大学附属第二医院育英儿童医院住院的诊断为川崎病且经静脉丙种球蛋白(IVIG)治疗的患儿共930例.根据开始IVIG治疗的时间将患儿分为2组:正常治疗组(病程10 d内接受治疗)和延迟治疗组(病程10 d后接受治疗),观察2组患儿病程1个月时的冠状动脉损害情况.同时收集患儿入院时IVIG使用前的实验室指标,根据各指标的中位数将2组患者分别进一步分为高水平组和低水平组,分析各指标的水平是否和延迟治疗冠状动脉损害间存在交互作用,同时分析治疗前是否使用激素及存在转科对延迟治疗冠状动脉损害的影响.结果:延迟治疗组冠状动脉损害的发生率明显高于正常治疗组(42.4% vs. 17.7%,P<0.001).交互作用分析显示,延迟治疗合并C反应蛋白(CRP)、红细胞沉降率(ESR)、中性粒细胞计数、谷草转氨酶升高,及白蛋白、红细胞计数下降时,冠状动脉损害的风险增加,尤其是延迟治疗合并CRP>79 mg/L,ESR>34 mm/h时发生冠状动脉损害的风险最高(分别OR=5.68,95% CI:1.17~27.59;OR=4.11,95% CI:1.62~10.46;均P<0.05).延迟治疗合并转科的患儿冠脉损害的风险亦增加(OR=7.29, 95% CI:1.85~45.17,P=0.0327).结论:川崎病患儿在病程10 d后接受IVIG治疗使冠状动脉损害的发生率增高,在病程10 d后接受IVIG治疗且合并高水平CRP、ESR、中性粒细胞计数、谷草转氨酶、低水平的红细胞计数及第一时间未入住儿童心血管科的患儿冠脉损害的风险增加,尤其合并CRP及ESR水平明显升高者出现冠状动脉损害的风险最大,两者间存在交互作用.%Objective: To identify the risk factors for coronary artery lesions with intravenous immunoglob-ulin (IVIG) treatment of Kawasaki disease (KD) 10 days after onset at different status. Methods: Nine hundred and thirty patients diagnosed as KD were collected from January 2009 to December 2014 at the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University. Patients were divided into the delayed IVIG therapy group (who received IVIG treatment after 10 days) and the conventional therapy group (who re-ceived IVIG treatment within 10 days). Coronary artery lesions between the two groups were compared. Risk factors for coronary artery lesions were investigated. Results: In the delayed IVIG therapy group, the frequency of coronary artery lesions within 1 month was higher(42.4% vs.17.7%,P0.001).The interaction analysis in-dicated that delayed IVIG therapy children with higher level of C-reaction protein(CRP,79 mg/L,OR=5.68, 95%CI:1.17-27.59, P0.05),erythrocyte sedimentation rate(ESR,34 mm/h,OR=4.11,95%CI:1.62-10.46, P0.05),neutrophils and aspartate transaminase had higher risk to develop coronary artery lesions.Delayed IVIG therapy with lower level of albumine, red blood cell also had higher risk to develop coronary artery lesions. Com-pared with controventional therapy group without changing of departement, the delayed therapy with changing of department had higher risk to develop coronary artery lesions(OR=7.29,95%CI:1.85-45.17,P=0.0327).Con-clusion: Delayed IVIG treatment leads to increased risk of coronary artery lesions in KD children. Delayd IVIG treatment combined with higher level of CRP, ESR, neutrophils, aspartate transaminase, lower level of red blood cell and not admitted to cardiology department at initial time has higher risk to develop coronary artery lesions.