García-Domínguez Miguel, Anaya-Enríquez Nancy, Luque-Vega Lynnete, Canizales-Muñoz Saúl, Flores Rosalino, Tostado-Morales Edgardo, Torres Cynthia G, Melchor Vianey, Quibrera José, Velázqueaz-Ríos Carlos, León-Ramírez Ángel Rito, Carreón-Guerrero Juan Manuel, Llausás-Magaña Eduardo
Departamento de Inmunología clínica, Hospital Pediátrico de Sinaloa, Culiacán, México.
Departamento de Pediatría, Hospital Pediátrico de Sinaloa, Culiacán, México.
Rev Alerg Mex. 2023 Jun 28;70(2):80-88. doi: 10.29262/ram.v70i3.1237.
To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C).
We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospi-talized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria be-tween May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups.
Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and lab-oratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symp-toms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C.
Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, signifi-cant differences such as severity of clinical presentation with multi-organ involvement and worst inflammato-ry response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C thanpatients with KD. Similar results have been observed in other studies where both disorders were compared.
评估川崎病（KD）患儿与多系统炎症综合征（MIS-C）患儿在临床表现、实验室检查结果及预后方面的异同。
我们进行了一项回顾性比较研究，纳入了2004年1月1日至2020年3月31日在锡那罗亚儿科医院住院的川崎病（KD）患儿，以及2020年5月1日至2021年5月31日符合世界卫生组织（WHO）病例定义标准的多系统炎症综合征（MIS-C）患者。比较了两组的人口统计学特征、流行病学数据、临床特征、实验室检查结果、治疗类型及临床结局。
共纳入81例患者（62例KD患者和19例MIS-C患者）。在这两种疾病实体之间发现了一些临床和实验室差异。KD组的中位年龄低于MIS-C组（25个月对79个月）。KD组中更常见的表现为男性（64.5%对47.4%）、黏膜皮肤特征（93.5%对63.2%）：口腔改变（83.9%对63.2%）和四肢改变（77.4%对57.9%）；KD的完全型（75.8%对47.4%）、冠状动脉瘤（16.1%对11.8%）。其次，MIS-C组比KD组更常见的表现为胃肠道受累（89.4%对9.6%）、休克（57.9%对3.2%）、神经系统症状（63.1%对11.2%）、肾脏受累（52.6%对16.1%）、总体心脏病（52.9%对29%）：心肌功能障碍（23.5%对11.3%）和心包积液（17.6%对2.9%）。淋巴细胞计数（2.07 + 2.03对4.28 + 3.01/mm³）、血小板计数（197.89 + 187.51对420.37 + 200.08/mm³）；血清白蛋白（2.29 + 0.65对3.33 + 0.06g/dL），以及CPR（21.4 + 11.23对14.26 + 12.37mg/dL）。KD组与MIS-C组的治疗类型：静脉注射免疫球蛋白（IVIG）（96.8%对94.7%）、全身用类固醇（4.82%对94.7%）、IVIG抵抗（19.4%对15.8%）。最后，KD组的死亡率为0%，MIS-C组为5.3%。
两组中发现了一些相似之处，如发热、皮疹和结膜炎。然而，MIS-C组比KD组更频繁地出现多器官受累的严重临床表现和更严重的炎症反应等显著差异，需要更多的液体补充、使用血管活性药物和更高剂量的类固醇。此外，MIS-C患者的死亡率高于KD患者。在其他比较这两种疾病的研究中也观察到了类似的结果。
