Children’s Heart Center, The Second Affiliated Hospital & Yuying Children’s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
These authors contributed equally to this work
Balkan Med J. 2020 Oct 23;37(6):324-329. doi: 10.4274/balkanmedj.galenos.2020.2020.1.56. Epub 2020 Jul 28.
Many children with Kawasaki disease develop coronary artery lesions before intravenous immunoglobulin treatment. However, little data are available on the prognosis of children with Kawasaki disease who developed coronary artery lesions before intravenous immunoglobulin treatment.
To explore the outcomes of coronary artery lesions before intravenous immunoglobulin treatment in children with Kawasaki disease and analyze the factors that influence the duration of coronary artery lesions.
Retrospective cohort study.
All patients with Kawasaki disease who developed coronary artery lesions before intravenous immunoglobulin treatment in our hospital from January 2009 to December 2014 were reviewed. A Cox proportional hazards model was used to determine the factors influencing the prognosis of coronary artery lesions.
Among 182 patients included, 28.6% were male, 83.50% were younger than 36 months, and 181 exhibited resolution of coronary artery lesions 2 years after disease onset. The median duration of coronary artery lesions was 31 days, and the proportion of coronary artery lesions was 52% at 1 month, 35% at 2 months, 33% at 3 months, 25% at 6 months, 14% at 1 year, and 0.5% at 2 years. The univariate analysis showed that overweight status, higher platelet count, lower albumin level, and starting treatment more than 10 days after disease onset were factors that possibly affect the duration of coronary artery lesions in children. The multivariate Cox regression analysis showed that female sex (adjusted hazard ratio, 1.661; 95% confidence interval, 1.117-2.470) was an independent protective factor, and overweight status (adjusted hazard ratio, 0.469; 95% confidence interval, 0.298-0.737), higher platelet count (adjusted hazard ratio, 0.649; 95% confidence interval, 0.443-0.950), and starting treatment more than 10 days after disease onset (adjusted hazard ratio, 0.392; 95% confidence interval, 0.215-0.716) were independent risk factors for a longer duration of coronary artery lesions.
The average duration of coronary artery lesions before intravenous immunoglobulin therapy in children with Kawasaki disease is approximately 1 month. Male gender, overweight status, higher platelet count, and initiation of treatment more than 10 days after the onset of the disease are independent risk factors for longer-lasting coronary artery lesions.
许多川崎病患儿在接受静脉注射免疫球蛋白治疗前已出现冠状动脉损伤。然而，关于川崎病患儿在接受静脉注射免疫球蛋白治疗前发生冠状动脉损伤的预后数据有限。
探讨川崎病患儿在接受静脉注射免疫球蛋白治疗前发生冠状动脉损伤的结局，并分析影响冠状动脉损伤持续时间的因素。
回顾性队列研究。
回顾性分析 2009 年 1 月至 2014 年 12 月我院收治的所有在静脉注射免疫球蛋白治疗前发生冠状动脉损伤的川崎病患儿。采用 Cox 比例风险模型确定影响冠状动脉损伤预后的因素。
在 182 例患儿中，28.6%为男性，83.50%年龄小于 36 个月，181 例患儿在发病后 2 年冠状动脉病变完全消退。冠状动脉损伤的中位持续时间为 31 天，1 个月时冠状动脉病变比例为 52%，2 个月时为 35%，3 个月时为 33%，6 个月时为 25%，1 年时为 14%，2 年时为 0.5%。单因素分析显示，超重状态、血小板计数较高、白蛋白水平较低以及发病后 10 天以上开始治疗是可能影响儿童冠状动脉损伤持续时间的因素。多因素 Cox 回归分析显示，女性（调整风险比，1.661；95%置信区间，1.117-2.470）是独立的保护因素，而超重状态（调整风险比，0.469；95%置信区间，0.298-0.737）、血小板计数较高（调整风险比，0.649；95%置信区间，0.443-0.950）以及发病后 10 天以上开始治疗（调整风险比，0.392；95%置信区间，0.215-0.716）是冠状动脉损伤持续时间较长的独立危险因素。
川崎病患儿在接受静脉注射免疫球蛋白治疗前冠状动脉损伤的平均持续时间约为 1 个月。男性、超重状态、血小板计数较高以及发病后 10 天以上开始治疗是冠状动脉损伤持续时间较长的独立危险因素。
