Satoh Kaoru, Wakejima Yoko, Gau Maki, Kiguchi Tomoyuki, Matsuda Nozomi, Takasawa Reiko, Takasawa Kei, Nishioka Masato, Shimohira Masayuki
Department of Pediatrics, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan.
Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan.
Int J Rheum Dis. 2018 Mar;21(3):746-754. doi: 10.1111/1756-185X.13223. Epub 2017 Nov 3.
To examine clinical characteristics of Kawasaki disease (KD) in infants younger than 3 months of age and to develop a method for detecting KD in febrile infants.
In a case-control study, we retrospectively collected clinical and laboratory data from 24 KD infants younger than 3 months of age out of 410 KD patients. We then compared younger infants with both older patients and febrile infants with respiratory syncytial virus (RSV) infection and urinary tract infections (UTI).
The frequency of incomplete KD was higher in the younger group than in the control group (79% vs. 36%, P < 0.0001). Furthermore, before treatment, the incidence of coronary artery lesions (CAL) was significantly higher in the younger group (29% vs. 3.9%, P = 0.0001), resulting in a higher incidence of coronary artery sequelae (21% vs. 3.4%, P = 0.0023). Our results revealed that the serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level of KD patients was higher than that of RSV and UTI patients (3110 ± 2076 vs. 698 ± 436, P = 0.0001; and 971 ± 589 pg/mL, P = 0.0002, respectively). Thus, NT-proBNP might be suitable as a diagnostic marker of KD in young infants (P = 0.0005, criterion values: 1555 pg/mL [sensitivity: 80%, specificity: 85%]).
Kawasaki disease infants younger than 3 months of age appear to be at higher risk for incomplete KD and early-onset CAL prior to the appearance of coronary artery sequelae. We suggest performing an echocardiogram and evaluating NT-proBNP in young infants with fever that has lasted longer than 2 days, regardless of the presence or absence of manifestations associated with KD.
研究3个月以下婴儿川崎病（KD）的临床特征，并建立一种检测发热婴儿川崎病的方法。
在一项病例对照研究中，我们回顾性收集了410例川崎病患者中24例3个月以下婴儿川崎病患者的临床和实验室数据。然后我们将年龄较小的婴儿与年龄较大的患者以及患有呼吸道合胞病毒（RSV）感染和尿路感染（UTI）的发热婴儿进行比较。
年龄较小的组中不完全川崎病的发生率高于对照组（79%对36%，P<0.0001）。此外，治疗前，年龄较小的组中冠状动脉病变（CAL）的发生率显著更高（29%对3.9%，P = 0.0001），导致冠状动脉后遗症的发生率更高（21%对3.4%，P = 0.0023）。我们的结果显示，川崎病患者的血清脑钠肽前体（NT-proBNP）水平高于RSV和UTI患者（分别为3110±2076对698±436，P = 0.0001；以及971±589 pg/mL，P = 0.0002）。因此，NT-proBNP可能适合作为幼儿川崎病的诊断标志物（P = 0.0005，临界值：1555 pg/mL[敏感性：80%，特异性：85%]）。
3个月以下的川崎病婴儿在冠状动脉后遗症出现之前，似乎发生不完全川崎病和早发性冠状动脉病变的风险更高。我们建议对持续发热超过2天的幼儿进行超声心动图检查并评估NT-proBNP，无论是否存在与川崎病相关的表现。
