Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
Pediatr Rheumatol Online J. 2021 Jun 26;19(1):96. doi: 10.1186/s12969-021-00589-z.
Coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD). Approximately 9-20% of the patients with KD develop CAL despite receiving regular treatment (intravenous immunoglobulin [IVIG] and aspirin). Some patients develop coronary aneurysms, leading to coronary artery stenosis or thrombosis, resulting in ischaemic heart disease and significantly affect the patients' lives. The purpose of this study was to investigate the factors associated with the duration of CAL in patients with KD.
The data of 464 patients with KD and CAL admitted to the Children's Heart Centre, The Second Affiliated Hospital and Yuying Children's Hospital from 2010 to 2018 were retrospectively analysed. Demographic and clinical information and echocardiographic follow-up data were collected. Kaplan-Meier curves were used to estimate the overall CAL duration, and the log-rank test was used to compare statistical differences. Univariate and multivariate Cox regression models were used to identify variables related to the CAL duration.
The median CAL duration was 46 days (95% confidence interval: 41-54 days). CALs were observed in 61.5, 41.5, 33.3, 22.3, 10.3, and 7.7% of the patients at 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after the onset of KD, respectively. Univariate Cox regression model showed that sex (p = 0.016), rash symptoms (p = 0.035), delayed IVIG treatment (p = 0.022), CAL type (p < 0.001), degree of CAL (p < 0.001), white blood cell count before IVIG treatment (p = 0.019), and platelet count after IVIG treatment (p = 0.003) were statistically significant factors associated with the overall CAL duration. Multivariable Cox regression showed that delayed IVIG treatment (p = 0.020), multiple dilatations (p < 0.001), a greater degree of dilatation (p < 0.001), and higher platelet count after IVIG treatment (p = 0.007) were positively related to CAL duration.
CAL duration was affected by delayed IVIG treatment, type of CAL, degree of CAL, and platelet count after IVIG treatment. These factors should be monitored carefully during the follow-up and management of patients with KD and CAL.
冠状动脉病变（CALs）是川崎病（KD）最严重的并发症。尽管接受了常规治疗（静脉注射免疫球蛋白[IVIG]和阿司匹林），但仍有约 9-20%的 KD 患者发生 CAL。一些患者会发展为冠状动脉瘤，导致冠状动脉狭窄或血栓形成，从而导致缺血性心脏病，并显著影响患者的生活。本研究旨在探讨与 KD 患者 CAL 持续时间相关的因素。
回顾性分析 2010 年至 2018 年期间在儿童心脏中心、第二附属医院和育英儿童医院收治的 464 例 KD 合并 CAL 患者的临床资料。收集患者的人口统计学和临床资料及超声心动图随访数据。采用 Kaplan-Meier 曲线估计总体 CAL 持续时间，并采用对数秩检验比较统计学差异。采用单因素和多因素 Cox 回归模型确定与 CAL 持续时间相关的变量。
CAL 持续时间的中位数为 46 天（95%置信区间：41-54 天）。KD 发病后 1 个月、2 个月、3 个月、6 个月、1 年和 2 年时，分别有 61.5%、41.5%、33.3%、22.3%、10.3%和 7.7%的患者出现 CAL。单因素 Cox 回归模型显示，性别（p=0.016）、皮疹症状（p=0.035）、IVIG 治疗延迟（p=0.022）、CAL 类型（p<0.001）、CAL 程度（p<0.001）、IVIG 治疗前白细胞计数（p=0.019）和 IVIG 治疗后血小板计数（p=0.003）与 CAL 总持续时间有关。多因素 Cox 回归分析显示，IVIG 治疗延迟（p=0.020）、多发性扩张（p<0.001）、扩张程度更大（p<0.001）和 IVIG 治疗后血小板计数较高（p=0.007）与 CAL 持续时间呈正相关。
CAL 持续时间受 IVIG 治疗延迟、CAL 类型、CAL 程度和 IVIG 治疗后血小板计数的影响。在 KD 和 CAL 患者的随访和管理中，应密切监测这些因素。
