Behmadi Maryam, Alizadeh Behzad, Malek Abdolreza
Department of Pediatric Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 99191-91778, Iran.
Pediatric and Congenital Cardiology Division, Department of Pediatric Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 99191-91778, Iran.
Med Sci (Basel). 2019 Apr 18;7(4):63. doi: 10.3390/medsci7040063.
The present study was performed to evaluate the clinical symptoms and cardiovascular complications in patients with typical and atypical Kawasaki disease (KD). This retrospective study was conducted on the medical records of 176 patients with KD for three years. The study population was divided into two groups of typical and atypical based on the KD clinical criteria. The two groups were compared in terms of demographic data, clinical symptoms, cardiac lesions, and laboratory markers. Based on the diagnostic criteria, 105 (60%) and 71 (40%) patients were diagnosed with typical and atypical KD, respectively. The mean age of the typical patients (38.16 months) was higher than that of the atypical group (24.03 months) at the time of diagnosis ( < 0.05). The results revealed no significant difference between the two groups regarding the seasonal distribution of KD onset ( = 0.422). However, the most common season for the diagnosis of the disease was spring, followed by winter. There was no significant difference between the two groups in terms of fever duration ( = 0.39). Furthermore, vomiting was more common in the atypical patients than in the typical group ( = 0.017). In terms of the cardiac lesions, ectasia ( = 0.005) and lack of tapering of the distal coronary vessels ( = 0.015) were more frequently detected in the atypical group than in the typical group. Considering the laboratory findings, thrombocytosis ( = 0.010) and anemia ( = 0.048) were more common in the atypical group, compared to those in the typical group. On the other hand, the typical group had a higher serum alanine aminotransferase level (adjusted for age) ( = 0.012) and Hyponatremia (serum sodium concentration ≤130 mmol/L) ( = 0.034). Based on the findings of the current study, the fever duration from onset to diagnosis was slightly more in atypical KD patients than in the typical group, but not statistically significant, possibly due to more timely diagnosis of atypical KD. There was no difference in coronary aneurysm between the two groups at the time of diagnosis. The atypical group had a higher frequency of coronary ectasia and lack of tapering, indicating cardiac involvement. Consequently, these conditions should be given more attention in the atypical patients. Furthermore, the higher frequency of anemia and thrombocytosis in the atypical patients can be useful for diagnosis of this kind of KD.
本研究旨在评估典型和非典型川崎病（KD）患者的临床症状和心血管并发症。这项回顾性研究对176例KD患者的病历进行了为期三年的分析。根据KD临床标准，将研究人群分为典型和非典型两组。比较两组的人口统计学数据、临床症状、心脏病变和实验室指标。根据诊断标准，分别有105例（60%）和71例（40%）患者被诊断为典型和非典型KD。诊断时，典型患者的平均年龄（38.16个月）高于非典型组（24.03个月）（P<0.05）。结果显示，两组KD发病的季节分布无显著差异（P=0.422）。然而，该病最常见的诊断季节是春季，其次是冬季。两组发热持续时间无显著差异（P=0.39）。此外，非典型患者呕吐比典型组更常见（P=0.017）。在心脏病变方面，非典型组比典型组更频繁地检测到冠状动脉扩张（P=0.005）和远端冠状动脉血管无逐渐变细（P=0.015）。考虑实验室检查结果，非典型组血小板增多症（P=0.010）和贫血（P=0.048）比典型组更常见。另一方面，典型组血清丙氨酸转氨酶水平（校正年龄后）更高（P=0.012），低钠血症（血清钠浓度≤130 mmol/L）更常见（P=0.034）。根据本研究结果，非典型KD患者从发病到诊断的发热持续时间比典型组略长，但无统计学意义，可能是由于非典型KD诊断更及时。两组诊断时冠状动脉瘤无差异。非典型组冠状动脉扩张和无逐渐变细的频率更高，提示心脏受累。因此，在非典型患者中应给予更多关注。此外，非典型患者贫血和血小板增多症的较高频率有助于此类KD的诊断。
