摘要
目的总结川崎病再发的临床特征并探讨其危险因素。方法回顾性分析2013年1月至2021年1月于重庆医科大学附属儿童医院风湿免疫科收治的因川崎病2次及以上入院的41例患儿(再发组)临床资料。并用简单随机数字法选取于本院随访至少6年无再发的123例川崎病患儿作为对照组。再发组根据发作的时间分为初发时和再发时。总结川崎病再发的临床特征,采用χ^(2)检验和Mann-Whitney U检验比较初发时和对照组危险因素的差异,并进行二元Logistic回归分析,并对相关因素进行受试者工作特征曲线分析。结果再发组41例患儿中男29例、女12例,其中33例(80%)于初发后2年内再发,8例(20%)于2年后再发。再发时外周血白细胞计数、静脉丙种球蛋白冲击前发热时间、指趾端硬肿均低于初发时[15.2(12.8~18.8)×10^(9)比18.0(14.9~23.4)×10^(9)/L、5.0(5.0~6.0)比6.0(5.0~7.5)d、54%(22/41)比76%(31/41),Z=-2.462、-3.329,χ^(2)=4.321,均P<0.05],再发时血红蛋白、血清白蛋白水平均高于初发时[(116±8)比(107±12)g/L、(39±5)比(36±6)g/L,t=-4.124、-3.009,均P<0.05]。多因素Logistic回归分析显示,C反应蛋白>97.5 mg/L(OR=3.014,95%CI 1.350~6.730,P=0.007)、血小板>276×10^(9)/L(OR=4.099,95%CI 1.309~12.838,P=0.015)、丙种球蛋白耐药(OR=9.239,95%CI 1.178~72.477,P=0.034)、肺炎支原体感染(OR=2.585,95%CI 1.129~5.922,P=0.025)均为川崎病再发的独立危险因素。经受试者工作特征曲线分析得出模型预测川崎病再发的曲线下面积为0.732(95%CI 0.647~0.817),截断值为0.241时,灵敏度为63.4%,特异度为70.7%。结论川崎病初次发作后应该至少密切随访2年,同时密切关注C反应蛋白值;初发时有肺炎支原体感染、丙种球蛋白耐药、C反应蛋白及血小板值升高的患儿发生川崎病再发风险更高。
Objective To summarize the clinical characteristics and explore the risk factors of recurrent Kawasaki disease.Methods In this retrospective study,reviewed 41 cases with recurrent Kawasaki disease in Department of Rheumatology and Immunology,Children′s Hospital of Chongqing Medical University from January 2013 to January 2021.And another 123 children with Kawasaki disease who had no recurrence during at least 6 years of follow-up were assigned into control group.Furthermore,the risk factors of recurrence were derived by comparing the clinical characteristics of recurrent cases at their initial episodes with those of control cases by Chi-square test and the Mann-Whitney U test,followed by Logistic regression and receiver operating characteristic analysis.Results There were 29 males and 12 females in 41 children with recurrent Kawasaki disease,33 children(80%)suffered a recurrence within 2 years after the first episode and 8 children(20%)developed a recurrence after 2 years.Compared with the first episode,the second episode had lower white blood cell count(15.2(12.8-18.8)×10^(9)vs.18.0(14.9-23.4)×10^(9)/L,Z=-2.462,P=0.014)and rate of edema in extremities(54%(22/41)vs.76%(31/41),χ^(2)=4.321,P=0.038),shorter fever durations before intravenous immunoglobulin treatment(5.0(5.0-6.0)vs.6.0(5.0-7.5)d,Z=-3.329,P=0.001)and higher levels of hemoglobin((116±8)vs.(107±12)g/L,t=-4.124,P<0.05)and albumin((39±5)vs.(36±6)g/L,t=-3.009,P=0.004).Multivariate Logistic regression analysis showed that C-reaction protein>97.5 mg/L(OR=3.014,95%CI 1.350-6.730,P=0.007),platelet>276×10^(9)/L(OR=4.099,95%CI 1.309-12.838,P=0.015),intravenous immunoglobulin resistance(OR=9.239,95%CI 1.178-72.477,P=0.034),Mycoplasma pneumoniae infection(OR=2.585,95%CI 1.129-5.922,P=0.025)were independent risk factors for recurrent Kawasaki disease recurrence.The predictive model then was generated using these four risk factors.The receiver operating characteristic analysis showed that the area under curve was 0.732(95%CI 0.647-0.817).When the cut-off w
作者
谭傲雪
唐雪梅
Aoxue Tan;Xuemei Tang(Department of Rheumatology and Immunology,Children′s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatric Infection and Immunity,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing 400014,China)
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2021年第12期1038-1042,共5页
Chinese Journal of Pediatrics
