Nakano H, Ueda K, Saito A, Tsuchitani Y, Kawamori J, Miyake T, Yoshida T
Am J Cardiol. 1986 Oct 1;58(9):739-42. doi: 10.1016/0002-9149(86)90348-6.
The beneficial effect of immunoglobulin in preventing coronary artery aneurysms in patients with Kawasaki disease is recognized, but immunoglobulin should be selectively given to patients at high risk for coronary lesions. The present study was designed to present a scoring method to evaluate the severity of Kawasaki disease in terms of coronary artery disease based on clinical and early laboratory findings. Seventy-eight patients who were admitted at 4 to 7 days of illness and who had received aspirin alone during the acute febrile period were separated into 2 groups according to significant coronary artery involvement, and possible related factors to the discrimination of the 2 groups were studied using multivariate analysis. Age at onset, C-reactive protein and platelet count contributed significantly to the discrimination, and from these 3 items a simple scoring system was devised to predict patients at high risk for coronary lesions. Retrospective study using this scoring method indicated that significant coronary artery disease was more often seen in patients predicted to be at high risk treated with aspirin, while no patients who received immunoglobulin had coronary lesions of moderate or severe degree. Thus, the present scoring method provides simple but clinically useful criteria for predicting patients at high risk of coronary artery disease, and immunoglobulin therapy for selected patients may reduce the significant coronary artery complications of Kawasaki disease.
免疫球蛋白在预防川崎病患者冠状动脉瘤方面的有益作用已得到认可，但应选择性地给予有冠状动脉病变高风险的患者。本研究旨在提出一种基于临床和早期实验室检查结果，根据冠状动脉疾病来评估川崎病严重程度的评分方法。78例在发病4至7天入院且在急性发热期仅接受阿司匹林治疗的患者，根据是否有明显冠状动脉受累分为2组，并使用多变量分析研究区分这2组的可能相关因素。发病年龄、C反应蛋白和血小板计数对区分有显著贡献，基于这3项指标设计了一个简单的评分系统来预测有冠状动脉病变高风险的患者。使用该评分方法的回顾性研究表明，预计为高风险的阿司匹林治疗患者中更常出现明显冠状动脉疾病，而接受免疫球蛋白治疗的患者中没有出现中度或重度冠状动脉病变。因此，本评分方法为预测冠状动脉疾病高风险患者提供了简单但临床有用的标准，对选定患者进行免疫球蛋白治疗可能会减少川崎病的严重冠状动脉并发症。
