Heart Center, Children's Hospital of Fudan University.
Department of Clinical Epidemiology, Children's Hospital of Fudan University.
J Epidemiol. 2020 Oct 5;30(10):429-435. doi: 10.2188/jea.JE20190065. Epub 2019 Sep 21.
We sought to investigate epidemiologic features of Kawasaki disease (KD) in Shanghai from 2013 through 2017 and identify risk factors for coronary artery lesions (CAL).
As in our previous three surveys, a set of questionnaires and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai. Medical records of KD patients diagnosed from January 2013 through December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for CAL.
A total of 4,452 cases were enrolled. Male-to-female ratio was 1.7:1. The incidence of KD was 68.8 to 107.3 per 100,000 children aged <5 years from 2013 to 2017. Age at onset ranged from 15 days to 14.0 years (median: 1.8 years). KD occurred more frequently in spring and summer. Of 4,325 patients (97.0%) receiving intravenous immunoglobulin (IVIG), 362 (8.4%) were resistant to initial IVIG. CAL occurred in 406 (9.1%) patients, including 118 (2.7%) with medium aneurysms and 31 (0.7%) with giant aneurysms. Recurrent cases were 60 (1.3%). No death was found in this survey. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were independently associated with CAL.
The incidence of KD in Shanghai had substantially increased while the proportion of CAL had substantially decreased as compared with our previous surveys. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were risk factors for CAL.
本研究旨在调查 2013 年至 2017 年上海川崎病（KD）的流行病学特征，并确定冠状动脉病变（CAL）的危险因素。
与我们之前的三项调查一样，向上海提供儿科医疗服务的 50 家医院发送了一套 KD 问卷和诊断指南。回顾性分析 2013 年 1 月至 2017 年 12 月诊断为 KD 的患者的病历。采用多因素 logistic 回归分析确定 CAL 的危险因素。
共纳入 4452 例患者。男女比例为 1.7:1。2013 年至 2017 年，<5 岁儿童 KD 的发病率为 68.8 至 107.3/10 万。发病年龄为 15 天至 14.0 岁（中位数：1.8 岁）。KD 多发生于春、夏季。4325 例（97.0%）接受静脉注射免疫球蛋白（IVIG）治疗的患者中，362 例（8.4%）对初始 IVIG 无反应。406 例（9.1%）患者发生 CAL，其中 118 例（2.7%）为中型动脉瘤，31 例（0.7%）为巨大动脉瘤。复发病例 60 例（1.3%）。本研究未发现死亡病例。较高的血小板水平、较低的白蛋白水平、男性、不完全 KD、IVIG 抵抗以及初始 IVIG 治疗≤4 天或>10 天与 CAL 独立相关。
与我们之前的调查相比，上海 KD 的发病率显著增加，而 CAL 的比例显著下降。较高的血小板水平、较低的白蛋白水平、男性、不完全 KD、IVIG 抵抗以及初始 IVIG 治疗≤4 天或>10 天是 CAL 的危险因素。
