Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado.
Divisions of Pediatric Hospital Medicine.
Hosp Pediatr. 2023 Jun 1;13(6):e153-e169. doi: 10.1542/hpeds.2023-007150.
Viral infections are suspected triggers in Kawasaki disease (KD); however, a specific viral trigger has not been identified.
In children with KD, to identify (1) overall prevalence of viral infections; (2) prevalence of specific viruses; and (3) whether viral positivity was associated with coronary artery aneurysms (CAAs) or refractoriness to intravenous immunoglobin (IVIG).
We searched Embase, Medline, and Cochrane databases and gray literature.
Eligible studies were conducted between 1999 and 2019, and included children diagnosed with KD who underwent viral testing.
Two investigators independently reviewed full-text articles to confirm eligibility, extract data, appraise for bias, and assess evidence quality for outcomes using the Grading of Recommendations Assessment Development and Evaluation criteria. We defined viral positivity as number of children with a positive viral test divided by total tested. Secondary outcomes were CAA (z score ≥2.5) and IVIG refractoriness (fever ≥36 hours after IVIG).
Of 3189 unique articles identified, 54 full-text articles were reviewed, and 18 observational studies were included. Viral positivity weighted mean prevalence was 30% (95% confidence interval [CI], 14-51) and varied from 5% to 66%, with significant between-study heterogeneity. Individual virus positivity was highest for rhinovirus (19%), adenovirus (10%), and coronavirus (7%). Odds of CAA (odds ratio, 1.08; 95% CI, 0.75-1.56) or IVIG refractoriness (odds ratio, 0.88; 95% CI, 0.58-1.35) did not differ on the basis of viral status.
Low or very low evidence quality.
Viral infection was common with KD but without a predominant virus. Viral positivity was not associated with CAAs or IVIG refractoriness.
病毒感染被怀疑是川崎病（KD）的触发因素；然而，尚未确定特定的病毒触发因素。
在 KD 患儿中，确定（1）病毒感染的总体患病率；（2）特定病毒的患病率；以及（3）病毒阳性是否与冠状动脉瘤（CAA）或静脉注射免疫球蛋白（IVIG）抵抗有关。
我们检索了 Embase、Medline 和 Cochrane 数据库以及灰色文献。
合格的研究于 1999 年至 2019 年进行，纳入接受病毒检测的确诊为 KD 的儿童。
两名研究者独立审查全文文章以确认合格性、提取数据、评估偏倚，并使用推荐评估、制定与评估分级标准评估结局的证据质量。我们将病毒阳性定义为阳性病毒检测的儿童数量除以总检测数。次要结局为 CAA（z 评分≥2.5）和 IVIG 抵抗（IVIG 后 36 小时仍发热）。
在 3189 篇独特的文章中，有 54 篇全文文章被审查，18 项观察性研究被纳入。病毒阳性的加权平均患病率为 30%（95%置信区间，14-51），范围从 5%到 66%，存在显著的研究间异质性。鼻病毒（19%）、腺病毒（10%）和冠状病毒（7%）的阳性率最高。CAA（比值比，1.08；95%置信区间，0.75-1.56）或 IVIG 抵抗（比值比，0.88；95%置信区间，0.58-1.35）的病毒状态无差异。
低或极低的证据质量。
病毒感染在 KD 中很常见，但没有一种主要的病毒。病毒阳性与 CAA 或 IVIG 抵抗无关。
