Zhao Li-li, Wang Yi-biao, Suo Lin
Department of Pediatrics, Nanyang Central Hospital, Nanyang, Henan 473000, China.
Zhonghua Er Ke Za Zhi. 2011 Jun;49(6):459-67.
Coronary artery lesion (CAL) is a serious complication of Kawasaki disease (KD). Whether there is CAL and the severity are the most critical factors of the prognosis of KD. The incidence of KD is currently increasing year by year. KD has replaced rheumatic fever as the main entity of acquired heart disease of children. This study aimed to identify risk factors of CAL secondary to KD and take early interventions to prevent CAL or reduce its incidence.
Literature search was performed at Chinese Academic Literature Main Database, Chinese Science and Technology Periodical Database, Wanfang Periodicals and Dissertation Database, and the Chinese Biomedical Literature Database comprehensively, besides, retrospective retrieval and manual retrieval were also performed from the domestic public actions and the dissertations dating from January, 2000 to December, 2009. RavMan 4.2 provided by Cochrane was used for meta analysis. Fixed or random model was selected according to the results of heterogeneity test. Sensitivity analysis was done according to the different results. The publication bias was evaluated by funnel plots. Odds ratio (OR) and 95% confidence interval (CI) were estimated in the dissertation.
Twenty studies were confirmed to be eligible. All the 20 studies were retrospective. OR and 95%CI of the risk factors were as follows: age ≤ 1 year, OR = 1.58, and 95%CI (1.23, 2.04), P = 0.0004; male gender, OR = 1.48, 95%CI (1.29, 1.71), P < 0.000 01; WBC > 20 × 10(9)/L, OR = 1.73, 95%CI (1.32, 2.26), P < 0.0001; C-reactive protein (CRP) > 100 mg/L, OR = 2.37, 95%CI (1.49, 3.77), P = 0.0003; fever duration > 10 d, OR = 3.23, 95%CI (2.08, 5.02), P < 0.000 01; use of intravenous gamma globulin (IVIG) > 10 d, OR = 2.50, 95%CI (1.98, 3.16), P < 0.000 01.
The high risk factors for coronary artery lesion secondary to Kawasaki disease are age ≤ 1 year, male, WBC > 20 × 10(9)/L, CRP > 100 mg/L, fever duration>10 d, and use of intravenous gamma globulin (IVIG) > 10 d.
冠状动脉病变（CAL）是川崎病（KD）的严重并发症。是否存在CAL及其严重程度是KD预后的最关键因素。目前KD的发病率逐年上升。KD已取代风湿热成为儿童后天性心脏病的主要病因。本研究旨在确定KD继发CAL的危险因素，并采取早期干预措施预防CAL或降低其发生率。
全面检索中国学术文献总库、中国科技期刊数据库、万方期刊及学位论文数据库、中国生物医学文献数据库，此外，还从国内公开资料及2000年1月至2009年12月的学位论文中进行回顾性检索和手工检索。采用Cochrane提供的RavMan 4.2进行荟萃分析。根据异质性检验结果选择固定或随机模型。根据不同结果进行敏感性分析。通过漏斗图评估发表偏倚。在论文中估计比值比（OR）和95%置信区间（CI）。
确认20项研究符合纳入标准。所有20项研究均为回顾性研究。CAL危险因素的OR及95%CI如下：年龄≤1岁，OR = 1.58，95%CI（1.23，2.04），P = 0.0004；男性，OR = 1.48，95%CI（1.29，1.71），P < 0.000 01；白细胞计数（WBC）> 20×10⁹/L，OR = 1.73，95%CI（1.32，2.26），P < 0.0001；C反应蛋白（CRP）> 100 mg/L，OR = 2.37，95%CI（1.49，3.77），P = 0.0003；发热持续时间> 10天，OR = 3.23，95%CI（2.08，5.02），P < 0.000 01；静脉注射丙种球蛋白（IVIG）使用时间> 10天，OR = 2.50，95%CI（1.98，3.16），P < 0.000 01。
川崎病继发冠状动脉病变的高危因素为年龄≤1岁、男性、WBC > 20×10⁹/L、CRP > 100 mg/L、发热持续时间> 10天及静脉注射丙种球蛋白（IVIG）使用时间> 10天。
