瑞士儿童川崎病的流行病学：一项全国前瞻性队列研究。

Epidemiology of Kawasaki Disease in children in Switzerland: a national prospective cohort study.

机构信息

Department of women-mother-child, Lausanne University Hospital, Lausanne, Switzerland.

Division of Pediatric Cardiology, Department of women-mother-child, Lausanne University Hospital, Lausanne, Switzerland.

出版信息

Swiss Med Wkly. 2022 May 26;152:w30171. doi: 10.4414/smw.2022.w30171. eCollection 2022 May 23.

DOI:10.4414/smw.2022.w30171

PMID:35748748

Abstract

AIM OF THE STUDY

Kawasaki disease is a febrile illness which can lead to significant coronary artery lesions. Its incidence varies among countries and is highest in Japan (330.2 children under 5 years old/100,000 per year). Since the epidemiology of Kawasaki disease in Switzerland is unknown, we conducted a national prospective data collection between 2013 and 2017 to describe its incidence, diagnosis, and treatment.

METHODS

We collected demographic and clinical data of the children under 17 years old hospitalised with Kawasaki disease in Switzerland between March 2013 and February 2017 using anonymous data collection forms with the help of the Swiss Paediatric Surveillance Unit (SPSU). We defined Kawasaki disease per the 2004 American Heart Association criteria: patients with ≥5 days of fever and ≥4 of the 5 main clinical features were included as complete Kawasaki disease and patients with ≥5 days of fever and <4 of the 5 main clinical features were included as incomplete Kawasaki disease. The incidence was calculated with the data of the Federal Statistical Office of Switzerland, considering permanent residents of the country. The different groups were compared by the unpaired student t-test for continuous variables and Pearson's chi squared test for categorical variables, respectively.

RESULTS

We included 175 patients: 60% were boys, with a mean age of 38.2 months. The incidence of Kawasaki disease was 3.1/100,000 [95% CI 2.6-3.7] per year in children under 17 years of age and 8.4/100,000 [95% CI 6.7-10.2] per year in children under 5 years of age. The most frequent clinical signs were a rash (85.4%) and changes of the lips and oral/pharyngeal mucosa (83.4%). The diagnosis of Kawasaki disease was made at a mean of 7.3 days after the first symptom. Echocardiography was abnormal in 52.3%. The treatment with intravenous immunoglobulins (IVIG) and acetylsalicylic acid was administered in accordance with international guidelines. Subgroup analysis showed that children older than 5 years old had significantly more complete Kawasaki disease than the younger ones (78.8% vs 57.4%, p = 0.021). Children with "extreme ages" (<1 year old and >8 years old) were diagnosed later (8.6 (±0.9) vs 7.0 (±0.3) days, p = 0.0129), had longer duration of fever (9.8 (±0.9) vs 8.1 (±0.3) days, p = 0.013) and had more echocardiographic abnormalities (n = 26 (70.3%) vs n = 65 (47.5%), p = 0.014) at diagnosis. One child died during the acute phase of the illness.

CONCLUSIONS

The incidence of Kawasaki disease in Switzerland is in the lower range of other European countries.

摘要

研究目的

川崎病是一种发热性疾病，可导致严重的冠状动脉病变。其发病率在各国之间存在差异，在日本最高（每 10 万人中有 330.2 名 5 岁以下儿童/年）。由于瑞士川崎病的流行病学情况未知，我们于 2013 年至 2017 年期间通过瑞士儿科监测单位（SPSU）使用匿名数据收集表进行了全国前瞻性数据收集，以描述其发病率、诊断和治疗情况。

方法

我们使用匿名数据收集表收集了 2013 年 3 月至 2017 年 2 月期间在瑞士因川崎病住院的 17 岁以下儿童的人口统计学和临床数据。我们根据 2004 年美国心脏协会标准定义川崎病：≥5 天发热和≥4 项主要临床特征的患者被纳入完全川崎病，≥5 天发热和<4 项主要临床特征的患者被纳入不完全川崎病。考虑到该国的常住居民，利用瑞士联邦统计局的数据计算发病率。通过未配对学生 t 检验比较连续变量，通过 Pearson 卡方检验比较分类变量。

结果

我们纳入了 175 名患者：60%为男性，平均年龄为 38.2 个月。17 岁以下儿童川崎病的发病率为每年每 100,000 人 3.1 [95%置信区间 2.6-3.7]，5 岁以下儿童为每年每 100,000 人 8.4 [95%置信区间 6.7-10.2]。最常见的临床体征是皮疹（85.4%）和唇及口腔/咽黏膜改变（83.4%）。川崎病的诊断平均在首发症状后 7.3 天做出。52.3%的患者存在超声心动图异常。静脉注射免疫球蛋白（IVIG）和乙酰水杨酸的治疗符合国际指南。亚组分析显示，5 岁以上儿童的完全川崎病比例明显高于 5 岁以下儿童（78.8% vs 57.4%，p = 0.021）。“极端年龄”（<1 岁和>8 岁）的儿童诊断时间较晚（8.6（±0.9）vs 7.0（±0.3）天，p = 0.0129），发热时间较长（9.8（±0.9）vs 8.1（±0.3）天，p = 0.013），超声心动图异常更多（n = 26（70.3%）vs n = 65（47.5%），p = 0.014）。有 1 名儿童在疾病急性期死亡。