Nomura Yuichi, Arata Michiko, Masuda Kiminori, Koriyama Chihaya, Suruki Nobutaka, Ueno Kentaro, Yoshikawa Hideki, Eguchi Taisuke, Kawano Yoshifumi
Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Pediatr Int. 2012 Feb;54(1):14-8. doi: 10.1111/j.1442-200X.2011.03512.x. Epub 2012 Jan 12.
A diagnosis of Kawasaki disease (KD) is established using six principal symptoms. Because the principal symptoms are deeply connected with KD, it is thus important to investigate the usefulness of the principal symptoms for evaluating the disease severity of KD.
Patients with definite KD or suspicion of KD were retrospectively examined. Blood test data and the incidence of patients who failed to respond to the initial i.v. immunoglobulin treatment (non-responders) were compared between patients with six principal symptoms, including fever of ≤ 4 days, before treatment of KD (six-symptom patients), and those with five or fewer symptoms (five-symptom patients).
The study group of 207 patients who were treated with immunoglobulin consisted of 121 six-symptom patients and 86 five-symptom patients. The six-symptom patients were older and had higher neutrophil proportion and total bilirubin, and lower serum sodium at diagnosis than the five-symptom patients. Although the treatments did not differ between the groups, the six-symptom patients had a higher incidence of non-responders than the five-symptom patients (17% vs 5%; P= 0.008). Logistic regression analysis showed that six-symptom status was related to the risk of being a non-responder (odds ratio [OR], 5.3; 95% confidence interval [95%CI]: 1.6-17.4). This association was still significant after adjustment for the effect of age, neutrophil proportion, and total bilirubin and sodium (OR, 4.4; 95%CI: 1.4-17.3).
The number of principal symptoms before treatment is a useful guide to KD disease severity. Six-symptom patients have a higher risk of being a non-responder than five-symptom patients.
川崎病（KD）的诊断基于六种主要症状。由于这些主要症状与KD密切相关，因此研究这些主要症状在评估KD疾病严重程度方面的实用性具有重要意义。
对确诊或疑似KD的患者进行回顾性研究。比较了KD治疗前出现包括≤4天发热在内的六种主要症状的患者（六症状患者）和出现五种或更少症状的患者（五症状患者）的血液检测数据以及对初始静脉注射免疫球蛋白治疗无反应患者（无反应者）的发生率。
接受免疫球蛋白治疗的207例患者研究组中，有121例六症状患者和86例五症状患者。六症状患者在诊断时年龄更大，中性粒细胞比例和总胆红素更高，血清钠更低。尽管两组治疗方法无差异，但六症状患者中无反应者的发生率高于五症状患者（17%对5%；P = 0.008）。逻辑回归分析显示，六症状状态与无反应风险相关（比值比[OR]，5.3；95%置信区间[95%CI]：1.6 - 17.4）。在调整年龄、中性粒细胞比例、总胆红素和钠的影响后，这种关联仍然显著（OR，4.4；95%CI：1.4 - 17.3）。
治疗前主要症状的数量是KD疾病严重程度的有用指标。六症状患者比五症状患者成为无反应者的风险更高
