川崎病合并消化道症状患儿的临床特征及发生冠状动脉病变的关联因素分析

肖红云; 李欢; 王金坤; 袁丽萍; 李婷; 韦国栋

doi:10.3969/j.issn.2095-5227.2022.12.007

川崎病合并消化道症状患儿的临床特征及发生冠状动脉病变的关联因素分析

Kawasaki disease with gastrointestinal symptoms in children: Clinical characteristics and factors associated with coronary artery lesions

摘要

摘要:
背景川崎病(Kawasaki disease，KD)是一种病因不明的发热性全身性血管炎综合征，也是儿童获得性心脏病的常见原因，目前川崎病患儿伴有消化系统症状与冠状动脉病变的关联尚无定论。
目的分析儿童川崎病合并消化道症状的临床特征并对患儿冠状动脉病变的关联因素进行探讨。
方法收集2016年1月- 2020年12月在安徽医科大学第一附属医院儿科诊断明确的急性期川崎病患儿的临床资料。根据是否合并消化道症状分为有消化道症状组和无消化道症状组，比较两组患儿的一般资料、各项实验室指标，分析伴有冠状动脉损害的相关危险因素。
结果共纳入269例患儿，男152例，女117例，年龄2个月 ~ 10岁。有消化道症状组与无消化道症状组年龄、颈淋巴结肿大、冠脉扩张、静脉注射免疫球蛋白(intravenous immunoglobulin，IVIG)延迟治疗、白细胞计数、免疫球蛋白、血清铁蛋白、血红蛋白、补体C4水平方面的差异均有统计学意义(P均＜0.05)。多因素logistic回归分析结果表明：伴有消化系统症状(OR=2.807，95% CI：1.055 ~ 7.465) 、年龄＜6岁(OR=3.806，95% CI：1.094 ~ 13.234)、IVIG首次注射时间≥10 d (OR=4.592，95% CI：1.095 ~ 19.262) 、血小板≥400 × 10⁹/L(OR=6.005，95% CI：1.619 ~ 22.273)与KD患儿并发冠状动脉病变独立关联(P均＜0.05)。
结论川崎病患儿合并消化道症状在婴幼儿中更常见，其中伴有消化系统症状、年龄＜6岁、IVIG首次注射时间≥10 d、血小板≥400 × 10⁹/L均是川崎病患儿并发冠状动脉病变的危险因素。

Abstract:
Background Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and a common cause of acquired heart disease in children. However, the relationship between presence of digestive symptoms and coronary artery lesions in Kawasaki disease is not clear .
Objective To explore the clinical characteristics of gastrointestinal symptoms in children with Kawasaki disease and analyze factors associated with occurrence of coronary artery lesions.
Methods Clinical data about children with acute Kawasaki disease diagnosed clearly in the Department of Pediatrics of the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2020 were collected. According to the presence or absence of gastrointestinal symptoms, the children were divided into with gastrointestinal symptoms group and without gastrointestinal symptoms group. The general data, laboratory indicators, and risk factors associated with coronary artery lesions were compared between the two groups.
Results Totally 269 cases were selected, including 152 males and 117 females, aged from 2 months to 10 years. There were significant differences in age, cervical lymphadenopathy, coronary artery dilation, delayed treatment with intravenous immunoglobulin (IVIG), white blood cell count, immunoglobulin, serum ferritin, hemoglobin, and complement C4 levels between the two groups (all P＜0.05). Multivariate logistic regression analysis showed that the presence of gastrointestinal symptoms (OR=2.807, 95% CI: 1.055-7.465), age＜6 years (OR=3.806, 95% CI: 1.094-13.234), time of first IVIG injection ≥ 10 d (OR=4.592, 95% CI: 1.095-19.262), platelets ≥400 × 10⁹/L (OR=6.005, 95% CI: 1.619-22.273) were independently associated with concomitant coronary artery disease in children with KD (all P＜0.05).
Conclusion Gastrointestinal symptoms in children with Kawasaki disease are more common in infants and toddlers. Gastrointestinal symptoms, age＜6 years, time of first IVIG injection ≥10 d, and platelets≥400 × 10⁹/L are associated with concomitant coronary artery lesions in children with Kawasaki disease.

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