川崎病与儿童期精神障碍：台湾基于人群的病例对照前瞻性研究。

Kawasaki disease in childhood and psychiatric disorders: A population-based case-control prospective study in Taiwan.

机构信息

School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung, Taiwan.

Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.

出版信息

Brain Behav Immun. 2022 Feb;100:105-111. doi: 10.1016/j.bbi.2021.11.017. Epub 2021 Nov 28.

DOI:10.1016/j.bbi.2021.11.017

PMID:34848339

Abstract

BACKGROUND

Kawasaki disease (KD) is a common childhood acute inflammatory disease and potentially triggers a chronic inflammation. Although some researches have investigated neurodevelopmental consequences following KD, the findings have been inconsistent. This is the first population-based study targeted on KD and common psychiatric disorders.

OBJECTIVES

We aimed to investigate the association between KD and psychiatric disorders and hypothesized that standard anti-inflammatory treatment by intravenous immunoglobulin (IVIG) may protect against development of psychiatric disorders.

METHOD

We retrieved data from Taiwan's National Health Insurance Research database (NHIRD). Patients (n = 282,513) with psychiatric disorders (the case group) during 1997-2013 were included, and the control group was matched with age, sex, income and urbanization (1:1). We calculated the prevalence of KD in both groups and estimated odd ratios (ORs) and 95% confidence intervals (CIs) in the subgroup analyses for KD in conditions of age, severity, and common psychiatric comorbidity.

RESULTS

Numbers of patients with KD were 460 in the cases and 380 in the controls (p = .006), and the crude OR of KD was 1.21 times greater (95% CI = 1.06-1.39, p = .006) in the case than the control groups. KD patients without IVIG treatment (n = 126) were higher in the cases than those in the controls (n = 54), with the OR of 2.33 (95% CI = 1.70-3.21, p < .0001). Subgroup analyses showed that KD survivors were at significant risk for autism spectrum disorders (ASD) (OR = 2.15, 95% CI = 1.27-3.65; p = .005) and attention deficit and hyperactivity disorders (ADHD) (OR = 1.19, 95% CI = 1.02-1.39; p = 0.03), and a trend of increased risk for anxiety disorders (OR = 1.36, 95%CI = 0.99-1.86; p = 0.05).

CONCLUSIONS

Patients with KD were more likely to have comorbid psychiatric disorders, including ASD and ADHD. Moreover, anti-inflammatory treatment with IVIG may have potential prophylactic effects against the development of psychiatric disorders.

摘要

背景

川崎病（KD）是一种常见的儿童急性炎症性疾病，可能引发慢性炎症。尽管一些研究已经调查了 KD 后的神经发育后果，但结果并不一致。这是第一项针对 KD 和常见精神疾病的基于人群的研究。

目的

我们旨在调查 KD 与精神疾病之间的关联，并假设静脉注射免疫球蛋白（IVIG）的标准抗炎治疗可能有助于预防精神疾病的发生。

方法

我们从台湾全民健康保险研究数据库（NHIRD）中检索数据。纳入 1997-2013 年期间患有精神疾病（病例组）的患者（n=282513），并按年龄、性别、收入和城市化程度（1:1）匹配对照组。我们计算了两组中 KD 的患病率，并在年龄、严重程度和常见精神共病的亚组分析中估计了 KD 的优势比（OR）和 95%置信区间（CI）。

结果

病例组中有 460 例 KD 患者，对照组中有 380 例（p=0.006），病例组 KD 的粗 OR 为 1.21 倍（95%CI=1.06-1.39，p=0.006）。未接受 IVIG 治疗的 KD 患者（n=126）在病例组中高于对照组（n=54），OR 为 2.33（95%CI=1.70-3.21，p<0.0001）。亚组分析显示，KD 幸存者患自闭症谱系障碍（ASD）（OR=2.15，95%CI=1.27-3.65；p=0.005）和注意缺陷多动障碍（ADHD）（OR=1.19，95%CI=1.02-1.39；p=0.03）的风险显著增加，焦虑障碍的风险呈增加趋势（OR=1.36，95%CI=0.99-1.86；p=0.05）。