Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia.
Eur J Pediatr. 2021 Aug;180(8):2599-2606. doi: 10.1007/s00431-021-04135-7. Epub 2021 Jun 4.
Data on Kawasaki disease from tropical countries are scarce. Hence, this population-based study aims to determine the epidemiology, clinical characteristics, and outcome of Kawasaki disease in children enrolled in the Kawasaki disease registry between 2006 and 2019 in Southern Malaysia. Diagnosis of Kawasaki disease was made using standard criteria. Primary outcome measure was a coronary artery aneurysm. Multivariable logistic regression was used to analyze the associated risk factors for coronary artery aneurysm. There were 661 Kawasaki disease, with 27% incomplete and 11% atypical presentations. Male-to-female ratio was 2:1, and median age of diagnosis was 1.4 years (interquartile range 9 to 32 months). Incidence in children of less than 5 years was 14.8 (95% confidence interval [CI]: 13.6 to 16.0) per 100,000 population, higher in males (19/100,000) and Chinese (22/100,000), with a gradual increase from 5.7/100,000 in 2006 to 19.6/100,000 in 2019, p < 0.001. Incidence in children between 5 and 9 years old was 1.3 (95% CI: 0.9 to 1.6) per 100,000 population and remained stable over time. There was a seasonal pattern with peak incidence during the rainy season. Out of 625 intravenous immunoglobulins (IVIG)-treated Kawasaki disease, 7.4% were resistant, and 9% had coronary artery aneurysms. Atypical presentation, male sex, late diagnosis, and IVIG resistance were independent risk factors for coronary artery aneurysms.Conclusions: Despite the tropical climate, Kawasaki disease epidemiology is similar to non-tropic regions with seasonal patterns and a rising incidence. Atypical presentation, male sex, late diagnosis, and IVIG resistance were significantly associated with coronary artery aneurysms. What is Known: • Kawasaki disease predominantly occurs in males, children less than 5 years old, and the Asian population. • Male sex, late diagnosis, incomplete Kawasaki disease, and IVIG resistance were associated with coronary artery aneurysms. What is New: • In multi-ethnic Asian countries such as Malaysia, ethnic Chinese have a higher prevalence of Kawasaki disease compared to other ethnicities. • Kawasaki disease with atypical presentation can occur in both complete and incomplete Kawasaki disease and is significantly associated with a coronary artery aneurysm.
来自热带国家的川崎病数据稀缺。因此，本项基于人群的研究旨在确定 2006 年至 2019 年期间在马来西亚南部川崎病登记处登记的儿童中川崎病的流行病学、临床特征和结局。川崎病的诊断采用标准标准。主要结局指标是冠状动脉瘤。多变量逻辑回归用于分析与冠状动脉瘤相关的危险因素。共 661 例川崎病，其中 27%为不完全表现，11%为不典型表现。男女性别比为 2:1，中位诊断年龄为 1.4 岁（四分位间距 9 至 32 个月）。5 岁以下儿童的发病率为每 10 万人中 14.8（95%置信区间：13.6 至 16.0），男性（19/100,000）和中国人（22/100,000）发病率较高，2006 年至 2019 年逐渐增加，从 5.7/100,000 增加至 19.6/100,000，p<0.001。5 至 9 岁儿童的发病率为每 10 万人中 1.3（95%置信区间：0.9 至 1.6），且随时间保持稳定。存在季节性模式，雨季发病率最高。在 625 例接受静脉注射免疫球蛋白（IVIG）治疗的川崎病中，有 7.4%为耐药，9%有冠状动脉瘤。不典型表现、男性、晚期诊断和 IVIG 耐药是冠状动脉瘤的独立危险因素。结论：尽管热带气候，川崎病的流行病学与具有季节性模式和发病率上升的非热带地区相似。不典型表现、男性、晚期诊断和 IVIG 耐药与冠状动脉瘤显著相关。已知：•川崎病主要发生在男性、5 岁以下儿童和亚洲人群中。•男性、晚期诊断、不完全川崎病和 IVIG 耐药与冠状动脉瘤相关。新发现：•在马来西亚等多民族的亚洲国家，与其他族裔相比，华裔的川崎病患病率更高。•不典型表现的川崎病可发生在完全和不完全川崎病中，与冠状动脉瘤显著相关。
