From the Department of Pediatrics, University of Colorado School of Medicine.
Children's Hospital Colorado, Section of Infectious Diseases and Epidemiology.
Pediatr Infect Dis J. 2019 Oct;38(10):1010-1014. doi: 10.1097/INF.0000000000002422.
To evaluate variations in treatment practice and compliance with national guidelines for the diagnostic evaluation of children with Kawasaki disease (KD).
We used the Pediatric Hospital Information System database to analyze demographic, laboratory and treatment data from patients admitted with KD between January 1, 2006, and December 31, 2015.
During the study period, 12,089 children with KD were diagnosed. Nearly all patients had a complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein ordered. Fewer patients had alanine aminotransferase (48.6%) or a urinalysis (75.3%). A small percentage of children had abdominal imaging (11.5%), neck imaging (5.9%), and lumbar punctures (4.5%), and 36.0% of patients received antibiotic therapy. Obtaining echocardiograms pretreatment and the use of steroids and infliximab significantly increased over the study period (P < 0.001). For patients who failed initial intravenous immunoglobulin (IVIG) monotherapy, 82.0% received a second dose of IVIG, 7.7% received steroids, 6.5% received infliximab, and 3.9% received combination therapy. Patients receiving infliximab or steroids as second therapy had a higher response rate than those who received only a second IVIG dose (87.9% versus 83.0% versus 73.3%, P < 0.001).
KD remains a challenging diagnosis. Opportunities exist for earlier use of echocardiograms in the evaluation of children with potential KD. Significant variations in practice exist surrounding second-line therapy. Our data suggest superiority of second-line therapy use of infliximab or steroids over IVIG in terms of reducing need for additional therapies. Prospective, controlled studies are needed to confirm this finding.
评估川崎病（KD）患儿诊断评估中治疗实践和遵循国家指南的变化。
我们使用儿科医院信息系统数据库，分析了 2006 年 1 月 1 日至 2015 年 12 月 31 日期间因 KD 入院的患者的人口统计学、实验室和治疗数据。
在研究期间，诊断出 12089 例 KD 患儿。几乎所有患者都进行了全血细胞计数、红细胞沉降率和 C 反应蛋白检测。较少患者进行了丙氨酸氨基转移酶（48.6%）或尿液分析（75.3%）。一小部分儿童进行了腹部成像（11.5%）、颈部成像（5.9%）和腰椎穿刺（4.5%），36.0%的患者接受了抗生素治疗。在研究期间，预处理时获得超声心动图、使用类固醇和英夫利昔单抗的比例显著增加（P<0.001）。对于初始静脉注射免疫球蛋白（IVIG）单药治疗失败的患者，82.0%接受了第二剂 IVIG，7.7%接受了类固醇，6.5%接受了英夫利昔单抗，3.9%接受了联合治疗。接受英夫利昔单抗或类固醇作为二线治疗的患者的反应率高于仅接受第二剂 IVIG 剂量的患者（87.9%比 83.0%比 73.3%，P<0.001）。
KD 仍然是一个具有挑战性的诊断。在评估有潜在 KD 风险的儿童时，有机会更早地使用超声心动图。二线治疗的实践存在显著差异。我们的数据表明，与 IVIG 相比，英夫利昔单抗或类固醇的二线治疗在减少额外治疗需求方面具有优势。需要进行前瞻性、对照研究来证实这一发现。
