Liu Xiaoliang, Wang Lin, Shao Shuran, Zhang Nanjun, Wu Mei, Liu Lei, Hua Yimin, Zhou Kaiyu, Yu Li, Wang Hua, Wang Chuan
Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education Chengdu, Chengdu, China.
Front Cardiovasc Med. 2022 May 11;9:856144. doi: 10.3389/fcvm.2022.856144. eCollection 2022.
Kawasaki disease (KD) is an acute systemic vasculitis and is becoming the leading cause of acquired cardiac disease in Children. Sterile pyuria is a known complication of KD. However, its associations with the inflammatory reaction severity, IVIG resistance as well as coronary artery lesions (CALs) in KD remain elusive.
We aimed to analyze the clinical profiles of sterile pyuria in KD, to determine whether sterile pyuria is an indicator of the disease severity in patients with KD, and to assess the associations between sterile pyuria and IVIG resistance as well as CALs.
We prospectively collected data from 702 patients with KD between January 2015 and June 2020. Profiles of patients with sterile pyuria (group A, = 63) were compared to those of patients without sterile pyuria (group B, = 639). The associations between sterile pyuria and IVIG resistance as well as CALs in KD were further determined by univariate and/or multivariate logistic regression analysis.
Sterile pyuria was observed in 9.0% of patients with KD, without predominance in age spectrum and gender. The levels of neutrophil percentages, alanine transaminase, total bilirubin, blood urea nitrogen, creatinine, the incidence of initial IVIG resistance, and rate of moderate/giant coronary artery aneurysms (CAAs) were significantly higher in group A than that in group B. Sterile pyuria was identified as an independent risk factor for initial IVIG resistance, yielding high specificity (92.7%) and low sensitivity (18.5%). However, sterile pyuria was not associated with repeated IVIG resistance and persistence of CALs in KD.
The incidence of sterile pyuria is relatively low in KD patients. Patients with sterile pyuria in KD exhibited a more severe inflammatory burden and were more likely to develop the initial IVIG resistance and moderate/giant CAAs. The overall prognosis of KD patients with sterile pyuria was satisfactory.
川崎病（KD）是一种急性全身性血管炎，正成为儿童后天性心脏病的主要病因。无菌性脓尿是KD已知的一种并发症。然而，其与KD炎症反应严重程度、静脉注射免疫球蛋白（IVIG）抵抗以及冠状动脉病变（CALs）之间的关联仍不明确。
我们旨在分析KD中无菌性脓尿的临床特征，确定无菌性脓尿是否为KD患者疾病严重程度的指标，并评估无菌性脓尿与IVIG抵抗以及CALs之间的关联。
我们前瞻性收集了2015年1月至2020年6月期间702例KD患者的数据。将无菌性脓尿患者（A组，n = 63）的特征与无无菌性脓尿患者（B组，n = 639）的特征进行比较。通过单因素和/或多因素逻辑回归分析进一步确定KD中无菌性脓尿与IVIG抵抗以及CALs之间的关联。
9.0%的KD患者出现无菌性脓尿，在年龄谱和性别上无明显优势。A组中性粒细胞百分比、丙氨酸转氨酶、总胆红素、血尿素氮、肌酐水平、初始IVIG抵抗发生率以及中度/巨大冠状动脉瘤（CAA）发生率均显著高于B组。无菌性脓尿被确定为初始IVIG抵抗的独立危险因素，具有高特异性（92.7%）和低敏感性（18.5%）。然而，无菌性脓尿与KD中反复IVIG抵抗和CALs的持续存在无关。
KD患者中无菌性脓尿的发生率相对较低。KD中有无菌性脓尿的患者表现出更严重的炎症负担，更有可能出现初始IVIG抵抗和中度/巨大CAA。KD伴有无菌性脓尿患者的总体预后良好。
