川崎病合并冠状动脉病变危险因素的多中心回顾性研究

张伦敏; 彭粤; 苏建军; 易岂建

doi:10.13406/j.cnki.cyxb.003662

重庆医科大学学报 ›› 2025, Vol. 50 ›› Issue (01) : 94 -97. DOI: 10.13406/j.cnki.cyxb.003662

临床研究

川崎病合并冠状动脉病变危险因素的多中心回顾性研究

张伦敏 ¹ ,
彭粤 ² ,
苏建军 ¹ ,
易岂建 ²

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Risk factors for Kawasaki disease comorbid with coronary artery lesion： a multicenter retrospective study

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摘要

目的通过对川崎病（kawasaki disease，KD）患儿临床特征及实验室指标分析，探讨KD合并冠状动脉损害（coronary artery lesions，CAL）的危险因素。方法选取2023年6月至2024年6月住院治疗的346例KD患儿为研究对象，其中遵义市第一人民医院住院患儿134例，重庆医科大学附属儿童医院住院患儿212例，根据有无CAL分为KD有CAL（KD-CAL）组和KD无CAL（KD-NCAL）组，对2组临床特征及实验室指标行差异性分析，共线性分析及多因素Logistic回归分析。结果 KD-CAL组与KD-NCAL组在年龄、免疫球蛋白（intravenous immunoglobulin，IVIG）冲击时间、皮疹、口唇变化、球结膜充血、四肢末梢改变、白细胞（white blood cell，WBC）、血红蛋白（hemoglobin，Hb）、中性粒细胞比例（N%）、血小板（platelet，PLT）、C反应蛋白（c-reactive protein，CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、丙氨酸氨基转氨酶（alanine aminotransferase，ALT）、血钠（Na）方面差异无统计学意义（P>0.05），而在性别、颈淋巴结肿大、高降钙素原（procalcitonin，PCT）、白蛋白（albumin，ALB）方面差异有统计学意义（P<0.05）。随后，多因素logistic回归分析结果显示男性（OR=1.886；95%CI=1.198~2.971；P=0.006），ALB（OR=0.938；95%CI=0.894~0.983；P=0.008）和PCT（OR=1.107；95%CI=1.007~1.207；P=0.035）与KD患者出现CAL独立相关。结论男性、低ALB、PCT是KD患儿合并CAL的独立危险因素。对于这类KD患儿，需要积极地早期干预避免后期CAL的发生。

Abstract

Objective To investigate the risk factors for Kawasaki disease（KD） comorbid with coronary artery lesion（CAL） by analyzing the clinical features and laboratory markers of children with KD. Methods A total of 346 children with KD who were hospitalized for treatment from June 2023 to June 2024 were enrolled as subjects，among whom there were 134 children from The First People’s Hospital of Zunyi and 212 children from Children’s Hospital of Chongqing Medical University. According to the presence or absence of CAL，the children were divided into KD group with CAL（KD-CAL group） and KD group without CAL（KD-NCAL group）. A difference analysis，a collinearity analysis，and the multivariate logistic regression analysis were performed for the clinical features and laboratory markers of the two groups. Results There were no significant differences between the KD-CAL group and the KD-NCAL group in age，time of intravenous immunoglobulin shock therapy，rash，lip changes，bulbar conjunctival hyperemia，peripheral changes of limbs，white blood cell count，hemoglobin，percentage of neutrophils，platelet count，C-reactive protein，erythrocyte sedimentation rate，alanine aminotransferase，and blood sodium（P>0.05），while there were significant differences between the two groups in sex，cervical lymphadenectasis，procalcitonin（PCT），and albumin（ALB）（P<0.05）. The subsequent multivariate logistic regression analysis showed that male sex（odds ratio［OR］=1.886，95%CI=1.198-2.971，P=0.006），ALB（OR=0.938，95%CI=0.894-0.983，P=0.008），and PCT（OR=1.107，95%CI=1.007-1.207，P=0.035） were independently associated with the presence of CAL in patients with KD. Conclusion Male sex，low ALB，and high PCT are independent risk factors for CAL in children with KD，and for such children，early intervention should be actively performed to avoid CAL.