Hu Hui-Min, Chen Xiao-Zheng, Zhang Yong-Lan, DU Zhong-Dong
Department of Cardiology, Beijing Children's Hospital, Capital Medical University/National Center for Children's Health, Beijing 100045, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Jun 15;24(6):681-686. doi: 10.7499/j.issn.1008-8830.2112094.
To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD.
The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (=284) and a non-liver damage group (=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD.
Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (<0.05).
Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.
总结川崎病（KD）急性期儿童肝损伤的临床特征，并探讨肝损伤对预测KD患儿冠状动脉病变及静脉注射免疫球蛋白（IVIG）无反应的临床价值。
收集2016年1月1日至2017年12月31日在北京儿童医院首次诊断为KD的925例患儿的病历资料。根据入院时丙氨酸氨基转移酶（ALT）水平是否异常，将患儿分为肝损伤组（n = 284）和非肝损伤组（n = 641）。采用logistic回归分析探讨包括肝损伤在内的各项指标对预测KD患儿冠状动脉病变及IVIG无反应的临床价值。
与非肝损伤组相比，肝损伤组入院时间明显更早，炎症指标血清水平明显更高（P<0.05）。肝损伤组入院时冠状动脉病变发生率明显高于非肝损伤组（P = 0.034）。初始IVIG治疗后，肝损伤组IVIG无反应患儿的比例明显高于非肝损伤组（P<0.001）。在KD患儿中，冠状动脉病变与血红蛋白水平降低、血小板计数、C反应蛋白和ALT升高有关（P<0.05），IVIG无反应与肢体变化、血红蛋白水平降低、血小板计数、C反应蛋白和ALT升高以及冠状动脉病变有关（P<0.05）。
与无肝损伤的患儿相比，KD早期有肝损伤的患儿临床症状出现较早，炎症指标水平较高，更易发生冠状动脉病变且对IVIG治疗无反应。
