Rosenfeld E A, Corydon K E, Shulman S T
Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, IL 60614, USA.
J Pediatr. 1995 Apr;126(4):524-9. doi: 10.1016/s0022-3476(95)70344-6.
To identify risk factors for severe sequelae, analyze disease characteristics, and assess efficacy of intravenously administered immune globulin (IVGG) therapy in infants less than 12 months of age with Kawasaki disease.
Retrospective chart review of children less than 12 months of age with Kawasaki disease between 1980 and 1993.
Of 443 patients with Kawasaki disease, 57 (13%) were less than 1 year of age, including 14 (3%) less than 6 months. Age at onset was a predictor of the development of coronary artery aneurysms (CAA) and of giant (> 8 mm) aneurysms: 11 (79%) of 14 children < 6 months and 17 (44%) of 39 children 6 to 12 months of age acquired CAA (p = 0.06), and 5 (37%) of 14 children < 6 months and 2 (5%) of 39 children 6 to 12 months of age acquired giant CAA (p < 0.01). No specific clinical or laboratory features predicted the development of CAA, which was found in 7 (29%) of 24 patients treated with IVGG by illness day 10 and in 21 (73%) of 29 patients treated after day 10 or never treated with IVGG (p < 0.01). Only 1 (4%) of 24 patients treated by day 10 but 6 (21%) of 29 children treated after day 10 or never treated with IVGG acquired giant CAA (p = 0.01). Persistent (> 1 year) CAA were present in 4 (17%) of 24 IVGG-treated children by day 10 and in 14 (48%) of 29 children not treated by day 10 or never treated with IVGG (p < 0.025). There was no difference in outcome if IVGG was given by illness day 7 or on illness days 8 to 10.
Patients with Kawasaki disease less than 6 months of age are at particularly increased risk of having CAA and giant CAA. Therapy with IVGG, given by illness day 10, is associated with substantial reduction in the frequency of CAA and giant CAA in this high-risk population.
确定重症后遗症的危险因素，分析疾病特征，并评估静脉注射免疫球蛋白（IVGG）疗法对12个月以下川崎病婴儿的疗效。
对1980年至1993年间12个月以下川崎病患儿进行回顾性病历审查。
在443例川崎病患者中，57例（13%）年龄小于1岁，其中14例（3%）年龄小于6个月。发病年龄是冠状动脉瘤（CAA）和巨大（>8mm）动脉瘤发生的一个预测因素：14例6个月以下儿童中有11例（79%）、39例6至12个月儿童中有17例（44%）发生CAA（p=0.06）；14例6个月以下儿童中有5例（37%）、39例6至12个月儿童中有2例（5%）发生巨大CAA（p<0.01）。没有特定的临床或实验室特征可预测CAA的发生，在病程第10天接受IVGG治疗的24例患者中有7例（29%）发生CAA，在病程第10天后接受治疗或从未接受IVGG治疗的29例患者中有21例（73%）发生CAA（p<0.01）。病程第10天接受治疗的24例患者中只有1例（4%）发生巨大CAA，但病程第10天后接受治疗或从未接受IVGG治疗的29例儿童中有6例（21%）发生巨大CAA（p=0.01）。病程第10天接受IVGG治疗的24例儿童中有4例（17%）存在持续性（>1年）CAA，病程第10天未接受治疗或从未接受IVGG治疗的29例儿童中有14例（48%）存在持续性CAA（p<0.025）。病程第7天或病程第8至10天给予IVGG，结局无差异。
6个月以下的川崎病患者发生CAA和巨大CAA的风险尤其增加。在病程第10天给予IVGG治疗，可使该高危人群中CAA和巨大CAA的发生率大幅降低。
