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儿童再发川崎病临床特征的Meta分析
Clinical features of children with recurrent Kawasaki disease: a Meta analysis
目的 探讨儿童再发川崎病（KD）的临床特点，以提高对再发KD的认识。方法 检索PubMed、Web of Science、Embase、中国知网、万方医学网和中国科技期刊数据库中关于儿童再发KD与初发时临床特点的对照研究，根据纳入、排除标准筛选文献，采用RevMan 5.3软件进行Meta分析。根据异质性检验结果选择相应效应模型进行数据合并，计算各观察指标合并比值比（OR）或加权均数差（WMD）及其95%CI。结果 最终纳入9个病例对照研究，KD患儿样本总量为12 059例，其中再发KD患儿206例（男127例，占61.7%；女79例，占38.3%）。Meta分析结果显示，与初发时相比，再发时发热时程缩短（WMD=-1.81，95%CI：-2.99~-0.64），手足硬肿率降低（OR=0.46，95%CI：0.26~0.80），差异均具有统计学意义（P < 0.05）；KD患儿再发时与初发时冠状动脉病变发生率的比较差异无统计学意义（OR=1.34，95%CI：0.84~2.14，P=0.22）。结论 目前证据显示再发KD患儿热程更短，手足硬肿率较低；KD再发以男童多见；再发患儿冠状动脉病变发生风险未见明显增高。
Objective To study the clinical features of children with recurrent Kawasaki disease (KD). Methods PubMed, Web of Science, Embase, CNKI, Wanfang Med Online, and Weipu Data were searched for case-control studies on the clinical features of initial and recurrent KD. The articles were screened according to the inclusion and exclusion criteria. RevMan 5.3 software was used to perform the Meta analysis. Effect models were selected based on the results of heterogeneity test, and then pooled OR or weighted mean difference (WMD), and their 95% CI were calculated. Results A total of 9 case-control studies were included, with 12 059 children with KD in total, among whom 206 children had recurrent KD (127 boys/61.7%; 79 girls/38.3%). The results of the Meta analysis showed that compared with the initial KD onset, the children with recurrent KD had a shorter duration of fever (WMD=-1.81, 95%CI:-2.99 to -0.64) and a lower proportion of children with swelling of the hands and feet (OR=0.46, 95%CI:0.26 to 0.80). There was no significant difference in the incidence rate of coronary artery lesions between recurrent KD and initial KD (OR=1.34, 95%CI:0.84 to 2.14). Conclusions Current evidence shows that children with recurrent KD tend to have a shorter duration of fever and a lower incidence of swelling of the hands and feet. KD recurrence is more common in boys. Current evidence does not show an increased risk of developing coronary artery lesions in children with recurrent KD.
Kawasaki disease / Meta analysis / Recurrence / Clinical feature / Child
[1] Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease:a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association[J]. Circulation, 2004, 110(17):2747-2771.
[2] Bell DM, Morens DM, Holman RC, et al. Kawasaki syndrome in the United States 1976 to 1980[J]. Am J Dis Child, 1983, 137(3):211-214.
[3] 付培培, 杜忠东, 潘岳松. 2002-2010年北京儿童医院川崎病住院患儿临床分析[J]. 实用儿科临床杂志, 2012, 27(9):661-664.
[4] 王宏伟, 程佩萱. 川崎病再发10例临床分析及文献复习[J]. 中国实用儿科杂志, 2003, 18(2):96-98.
[5] 孔东明, 邓淑珍, 王瑞耕, 等. 川崎病再发22例[J]. 实用儿科临床杂志, 2012, 27(21):1668-1669.
[6] 姚晓利, 张静. 儿童再发川崎病77例临床特征回顾性分析[J]. 中国循证儿科杂志, 2013, 8(6):442-446.
[7] 刘仕成, 朴金花, 韩燕燕. 再发川崎病13例临床分析[J]. 中华临床医师杂志(电子版), 2010, 4(7):1123-1124.
[8] 邹丽霞, 龚方戚. 再发川崎病20例临床分析[J]. 中国当代儿科杂志, 2008, 10(5):617-619.
[9] 王珍全, 金佳蕙, 荣星, 等. 再发川崎病17例临床分析[J]. 浙江临床医学, 2014, 16(8):1279-1280.
[10] Yang HM, Du ZD, Fu PP. Clinical features of recurrent Kawasaki disease and its risk factors[J]. Eur J Pediatr, 2013, 172(12):1641-1647.
[11] 王芳洁, 孙力安, 冯迎军. 川崎病再发9例[J]. 中外健康文摘, 2013(39):80-82.
[12] Nakamura Y, Yashiro M, Uehara R, et al. Epidemiologic features of Kawasaki disease in Japan:results of the 2009-2010 nationwide survey[J]. J Epidemiol, 2012, 22(3):216-221.
[13] McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease:a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17):e927-e999.
[14] Tremoulet AH, Best BM, Song S, et al. Resistance to intravenous immunoglobulin in children with Kawasaki disease[J]. J Pediatr, 2008, 153(1):117-121.
[15] Kobayashi T, Fuse S, Sakamoto N, et al. A new Z score curve of the coronary arterial internal diameter using the Lambda-Mu-Sigma method in a pediatric population[J]. J Am Soc Echocardiogr, 2016, 29(8):794-801.e29.
[16] Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].[2020-04-10]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
[17] Chahal N, Somji Z, Manlhiot C, et al. Rate, associated factors and outcomes of recurrence of Kawasaki disease in Ontario, Canada[J]. Pediatr Int, 2012, 54(3):383-387.
[18] Maddox RA, Holman RC, Uehara R, et al. Recurrent Kawasaki disease:USA and Japan[J]. Pediatr Int, 2015, 57(6):1116-1120.
[19] de La Harpe M, di Bernardo S, Hofer M, et al. Thirty years of Kawasaki disease:a single-center study at the University Hospital of Lausanne[J]. Front Pediatr, 2019, 7:11.
[20] Nakamura Y, Yashiro M, Uehara R, et al. Epidemiologic features of Kawasaki disease in Japan:results of the 2007-2008 nationwide survey[J]. J Epidemiol, 2010, 20(4):302-307.
[21] Kim GB, Park S, Eun LY, et al. Epidemiology and clinical features of Kawasaki disease in South Korea, 2012-2014[J]. Pediatr Infect Dis J, 2017, 36(5):482-485.
[22] Sudo D, Nakamura Y. Nationwide surveys show that the incidence of recurrent Kawasaki disease in Japan has hardly changed over the last 30 years[J]. Acta Paediatr, 2017, 106(5):796-800.
[23] 李菲, 周娟, 丁媛, 等. 单中心6年川崎病住院患儿早期并发冠状动脉瘤危险因素分析[J]. 中华实用儿科临床杂志, 2019, 34(9):680-683.
[24] Sharma SD, Chaturvedi K, Saini A, et al. Recurrence of coronary artery lesions after complete regression in a peculiar case of Kawasaki disease[J]. Cardiol Young, 2019, 29(5):714-716.
泰山学者工程资助（2018）。
