摘要
目的以川崎病(KD)并发巨大冠状动脉瘤(GCAA)的病例对照研究,分析KD急性期的临床特征,并探讨并发GCAA的危险因素。方法选取2001年5月至2009年5月在广州市妇女儿童医疗中心儿童医院住院的KD并发GCAA患儿为GCAA组;选取同期KD并发中小冠状动脉瘤(CAA)患儿为对照组。对两组患儿的临床特征进行比较,对可能影响GCAA发生的因素进行单因素分析,并进行多因素Logistic逐步回归分析。结果GCAA组纳入22例,其中男19例,女3例,发病年龄3个月至10岁,平均(2.9±2.8)岁。中小CAA组纳入65例,其中男51例,女14例。Pearsonχ2检验结果提示,年龄≤6个月或≥5岁、发热时间>14d、延误诊断、确诊前单独使用糖皮质激素、Hb降低、ESR升高和ALB降低与GCAA发生相关(P均<0.05)。多因素Logistic逐步回归分析提示,延误诊断(OR=2.998,95%CI:1.004～8.950,P=0.047),确诊前单独使用糖皮质激素(OR=6.556,95%CI:1.561～28.542,P=0.010),ESR≥100mm.h-1(OR=3.591,95%CI:1.164～11.079,P=0.026)为发生GCAA的独立危险因素。结论延误诊断、确诊前单独使用糖皮质激素和ESR≥100mm.h-1为KD并发GCAA的独立危险因素。
Objective To analyze the clinical features of children with giant coronary artery aneurysms（GCAA） caused by Kawasaki disease（KD） in acute stage and investigate the risk factors of GCAA. Methods From May 2001 to May 2009,inpatients diagnosed as KD in Children＇s Hospital, Guangzhou Women and Children Medical Care Centre were enrolled into the study. Inpatients diagnosed as KD with coronary arterial dilation （ CAD ） or without coronary arterial lesion （ CAL ） were excluded, but inpatients with delayed diagnosis as KD with CAA were included. Patients with incomplete information were also excluded. Sex, age, clinical manifestations,laboratory examination and treatment of patients were collected. Sex（ male, female） , fever（ ~〈 14 d, 〉 14 d） , delayed diagnosis,WBC[ 〈 12, - 20,≥ 20 （ × 10^9·L-1 ） ] ,PLTmax [ 〈400, - 800,≥800 （ ×10^9 . L-1 ） ] ,PLTmin [ 〈 100, - 400,≥400 （ ×10^9·L-1）,Hb[ 〈90,-110,≥110 （g· L-1）],ESR[ 〈100, t〉100 （mm·h-1）],CRP[ 〈3, -50,≥50 （mg· L-1 ） ] ,ALB[ 〈30,≥30 （mg · L-1 ） ] ,days of using IVIG（ ≤10 d, 〉 10 d） and the use of corticosteroid before diagnosis were chosen as risk factors of GCAA to be analyzed. The risk factors of GCAA caused by KD were estimated by Chi-square test and Logistic regression analysis. Results According to the inclusion and exclusion criteria,22 patients with GCAA were enrolled into GCAA group. The average age was （ 2.9 ± 2.8 ） years （ 3 months - 10 years ）. 65 patients with small or medium coronary artery aneurysms （CAA） were enrolled into control group. The average age was （ 1.5 ± 1.2 ） years （ 3 months to 6 years）. There was significant difference in delayed diagnosis （ P 〈 0.05 ） , but no difference in clinical manifestations. The results of Chi-square test showed that the age≤6 months or ≥5 years , fever lasting over 14 days, delayed diagnosis, use of eorticosteroid before KD was diagnosed , higher ESR, lower Hb and ALB were associated wi
出处
《中国循证儿科杂志》
CSCD
2009年第5期411-416,共6页
Chinese Journal of Evidence Based Pediatrics
基金
广东省科学技术厅基金项目:53063
关键词
川崎病
巨大冠状动脉瘤
临床特征
危险因素
Kawasaki disease
Giant coronary artery aneurysm
Clinical features
Risk factors
