Shashaani Niloufar, Shiari Reza, Karimi Abdullah, Salehi Shima, Ghanaei Roxana, Hassas Yeganeh Mehrnoush, Shiari Sara, Rahmani Khosro, Javadi Parvaneh Vadood
Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Pediatric Rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Open Access Rheumatol. 2020 Aug 26;12:187-192. doi: 10.2147/OARRR.S255138. eCollection 2020.
Kawasaki disease (KD) is a systemic vasculitis that occurs mostly in children under five years old. Kawasaki affects the middle-size arteries, especially the coronary arteries. Therefore, without adequate treatment, it may cause coronary artery aneurysm in 25% of patients. The purpose of this study was to investigate the relationship between Kobayashi, Sano, and Egami criterions with coronary artery aneurysm in KD patients during the last ten years and to identify risk factors in patients with intravenous immunoglobulin (IVIG)-resistant and coronary artery aneurysms.
Medical records of 363 Kawasaki patients referred during 2008-2017 were reviewed. Patients' demographic data and Kobayashi, Sano, and Egami scores of each patient were calculated. Based on echocardiographic findings, cases of coronary artery aneurysm were determined. Sensitivity, specificity, positive and negative predictive value, and the accuracy of each criterion were determined to predicting IVIG resistance and detect coronary artery aneurysm.
There was a slight relationship between IVIG-resistance in Kawasaki children and its prediction based on the Kobayashi risk score, but no relationship was found between the Egami and Sano criteria. Sixty-three patients (17.4%) had coronary artery lesions (CALs) on time of diagnosis. There were no statistically significant differences between gender and mean age of children with and without CALs. Also, there was no significant relationship between coronary artery aneurysm in Kawasaki children and its prediction based on the above three risk factors. The area under the ROC-curve of all three risk measures of Kobayashi, Egami, and Sano indicated that all three criteria were not useful in predicting CALs.
Despite the low accuracy of the three above criteria to predictive of patients with IVIG resistance, it seems that the variables of age, duration of fever, and C-reactive protein (CRP) are more useful than other variables and may be utilized to evaluate patients by establishing a more appropriate cut-off point.
川崎病（KD）是一种主要发生在5岁以下儿童的全身性血管炎。川崎病会影响中等大小的动脉，尤其是冠状动脉。因此，若未得到充分治疗，25%的患者可能会出现冠状动脉瘤。本研究的目的是调查过去十年间小林、佐野和江上标准与川崎病患者冠状动脉瘤之间的关系，并确定静脉注射免疫球蛋白（IVIG）抵抗且患有冠状动脉瘤的患者的风险因素。
回顾了2008年至2017年期间转诊的363例川崎病患者的病历。计算了患者的人口统计学数据以及每位患者的小林、佐野和江上评分。根据超声心动图检查结果确定冠状动脉瘤病例。确定了各标准预测IVIG抵抗和检测冠状动脉瘤的敏感性、特异性、阳性和阴性预测值以及准确性。
川崎病患儿的IVIG抵抗与其基于小林风险评分的预测之间存在轻微关系，但江上和佐野标准之间未发现关系。63例患者（17.4%）在诊断时患有冠状动脉病变（CALs）。有CALs和无CALs的儿童在性别和平均年龄上无统计学显著差异。此外，川崎病患儿的冠状动脉瘤与其基于上述三个风险因素的预测之间也无显著关系。小林、江上和佐野所有三个风险指标的ROC曲线下面积表明，这三个标准对预测CALs均无用。
尽管上述三个标准预测IVIG抵抗患者的准确性较低，但年龄、发热持续时间和C反应蛋白（CRP）等变量似乎比其他变量更有用，通过建立更合适的切点，可用于评估患者。
