Department of Pediatrics, Bahrami Hospital, Tehran University of Medical Sciences, Shahid Kiaee Street (Ghasem Abad), Damavand Street, Tehran, 1641744991, Iran.
Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran.
BMC Infect Dis. 2021 Apr 19;21(1):368. doi: 10.1186/s12879-021-06046-2.
Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years.
A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008-2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment.
Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found.
As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.
川崎病（KD）是一种急性全身性血管炎，是 5 岁以下儿童获得性心脏病的主要原因。
设计了一项 10 年的回顾性横断面研究，以评估 2008 年至 2018 年期间的 190 名伊朗儿童的 KD。评估了从症状发作到诊断的人口统计学数据、临床和实验室表现、临床体征和症状以及随后的治疗，以预测住院时间、并发症和治疗反应。
KD 患儿男女比例为 1.18:1，平均年龄为 36 个月。在寒冷季节 KD 的发病率略高。最常见的症状是发热（92.6%）、口腔黏膜改变（75.8%）、双侧球结膜充血（73.7%）、多形性皮疹（73.2%）、外周肢体改变（63.7%）和颈部淋巴结肿大（60.0%）。胃肠道、心脏、关节和肝脏并发症的发生率分别为 38.4%、27.9%、6.8%和 4.2%。89.5%的患者接受静脉注射免疫球蛋白（IVIG）加阿司匹林作为一线治疗，而 16.3%的患者需要二线治疗。KD 合并心脏并发症的患者血清钠水平显著降低，血小板计数显著升高。心脏并发症常发生在未对一线治疗有反应的患者中。血小板计数升高、血清钠量降低和 C 反应蛋白（CRP）水平升高与需要二线治疗有显著相关性。住院时间与血红蛋白水平之间存在显著相关性。
由于大多数临床表现和并发症与过去几年发表的其他报告相似，因此可以有信心地将这些数据用于伊朗的 KD 诊断。季节性发病和相当数量的患者近期感染史可能为了解 KD 的可能病因提供线索。实验室标志物可以成功地为临床医生提供额外治疗、可能的并发症和住院时间的临床判断。
