Downie Mallory L, Manlhiot Cedric, Collins Tanveer H, Chahal Nita, Yeung Rae S M, McCrindle Brian W
Labatt Family Heart Centre, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada.
Labatt Family Heart Centre, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada.
Int J Cardiol. 2017 Jun 1;236:157-161. doi: 10.1016/j.ijcard.2017.01.068. Epub 2017 Jan 8.
While the risk is reduced, patients may develop coronary artery (CA) aneurysms after Kawasaki disease (KD) despite receiving intravenous immunoglobulin (IVIG) within 10days of symptom onset. Risk factors for CA aneurysms may differ compared to those patients with delayed or no treatment.
Patients diagnosed with KD between 1990 and 2013 were included. Patients with maximum coronary artery z-scores>5 were classified as having CA aneurysms. Separate multivariable regression models were used to determine factors associated with CA aneurysms for those with versus without prompt treatment.
Of 1358 patients included, 83% (n=1126) were treated with IVIG within 10days and 5% (n=53) developed CA aneurysms. Patients who had delayed (>10days) or no IVIG treatment were at increased odds of developing CA aneurysms (OR: 3.1,95% CI: 1.9-5.1, p<0.001). For patients with prompt treatment with IVIG, factors associated with increased odds of CA aneurysms were: longer duration of fever prior to treatment (OR: 1.2/day, p=0.04), age<1year (OR: 3.9, p=0.001), higher pre-IVIG white blood cell count (OR: 1.05/×10/L, p=0.007), lower hemoglobin (OR: 1.4/g/L, p=0.004) and non-response to initial IVIG treatment (OR: 2.5, p<0.001). For patients with delayed or no treatment, factors associated with increased odds of CA aneurysms were: males (OR: 5.4, p=0.009), age<1year (OR: 29.9, p<0.001), and higher platelet count (OR: 1.4/100×10/L, p=0.001). Delayed treatment with IVIG did not reduce the risk of CA aneurysms (OR: 1.9, p=0.28), and total duration of fever was not associated with CA aneurysms for this group (OR: 1.04/day, p=0.16).
Factors associated with the development of CA aneurysms are generally similar for those treated promptly versus those with delayed or no treatment. For those with delayed diagnosis, treatment with IVIG does not appear to be effective to prevent CA aneurysms.
尽管风险有所降低，但川崎病（KD）患者在症状出现后10天内接受静脉注射免疫球蛋白（IVIG）治疗仍可能发生冠状动脉（CA）瘤。与延迟治疗或未治疗的患者相比，CA瘤的危险因素可能有所不同。
纳入1990年至2013年间诊断为KD的患者。冠状动脉最大z值>5的患者被分类为患有CA瘤。使用单独的多变量回归模型来确定及时治疗与未及时治疗的患者中与CA瘤相关的因素。
在纳入的1358例患者中，83%（n=1126）在10天内接受了IVIG治疗，5%（n=53）发生了CA瘤。延迟（>10天）或未接受IVIG治疗的患者发生CA瘤的几率增加（比值比：3.1，95%置信区间：1.9-5.1，p<0.001）。对于及时接受IVIG治疗的患者，与CA瘤几率增加相关的因素包括：治疗前发热时间较长（比值比：1.2/天，p=0.04）、年龄<1岁（比值比：3.9，p=0.001）、IVIG治疗前白细胞计数较高（比值比：1.05/×10/L，p=0.007）、血红蛋白较低（比值比：1.4/g/L，p=0.004）以及对初始IVIG治疗无反应（比值比：2.5，p<0.001）。对于延迟治疗或未治疗的患者，与CA瘤几率增加相关的因素包括：男性（比值比：5.4，p=0.009）、年龄<1岁（比值比：29.9，p<0.001）以及血小板计数较高（比值比：1.4/100×10/L，p=0.001）。IVIG延迟治疗并未降低CA瘤的风险（比值比：1.9，p=0.28），并且该组患者的发热总时长与CA瘤无关（比值比：1.04/天，p=0.16）。
及时治疗的患者与延迟治疗或未治疗的患者中，与CA瘤发生相关的因素总体相似。对于诊断延迟的患者，IVIG治疗似乎无法有效预防CA瘤。
