OBJECTIVE: To study risk factors for the development of coronary artery lesions (CAL) in children with Kawasaki disease (KD). METHODS: The clinical data of 527 children with KD between January 2006 and January 2009 were retrospectively reviewed. A total of 15 potential factors associated with occurrence of CAL were evaluated by univariate analysis and multivariate logistic regression analysis. RESULTS: The univariate analysis showed that age, gender, KD type, starting time of intravenous immunoglobulin (IVIG) treatment, response to IVIG treatment, additional treatment with corticosteroids, duration of fever and serum C-reactive protein level were significantly different between patients with and without CAL (P<0.05). Multivariate logistic regression analysis showed that an age of less than 1 year (OR=2.076, P<0.05) or greater than 8 years (OR=1.890, P<0.05), male sex (OR=1.972, P<0.05), incomplete KD (OR=1.426, P<0.05), delayed starting time of IVIG treatment (10 days after onset) (OR=3.251, P<0.05), no response to IVIG (OR=2.301, P<0.05) and fever duration of more than 10 days (OR=1.694, P<0.05) were independent risk factors for the development of CAL, whereas early starting time of IVIG treatment (before 5 days after onset) was a protective factor (OR=0.248, P<0.05). CONCLUSIONS: The occurrence of CAL is associated with many factors in children with KD. Age of less than 1 year or greater than 8 years, male sex, incomplete KD, delayed IVIG treatment after onset, no response to IVIG treatment and prolonged fever duration have been identified as risk factors for the development of CAL.
Key words
Kawasaki disease /
Coronary artery lesions /
Intravenous immunoglobulin /
Corticosteroid /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
［1］Coustasse A, Larry J, Lee D. Can Kawasaki disease be managed?［J］. Perm J, 2012, 16(2): 70-72.
［2］Alexopoulos A, Vekiou A, Lycopoulou L, Tavena A, Lagona E, Kakourou T. Kawasaki disease in Greek children: a retrospective study［J］. J Eur Acad Dermatol Venereol, 2012, doi: 10.1111/j. 1468-3083. 2012.04488.x.［Epub ahead of print］.
［3］Daniels LB, Tjajadi MS, Walford HH, Jimenez-Fernandez S, Trofimenko V, Fick DB Jr, et al. Prevalence of Kawasaki disease in young adults with suspected myocardial ischemia［J］. Circulation, 2012, 125(20): 2447-2453.
［4］Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, 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.
［5］McMorrow Tuohy AM, Tani LY, Cetta F, Lewin MB, Eidem BW, Van Buren P, et al. How many echocardiograms are necessary for follow-up evaluation of patients with Kawasaki disease?［J］. Am J Cardiol, 2001, 88(3): 328-330.
［6］Scott JS, Ettedgui JA, Neches WH. Cost-effective use of echocardiography in children with Kawasaki disease［J］. Pediatrics, 1999, 104(5): e57.
［7］Callinan LS, Tabnak F, Holman RC, Maddox RA, Kim JJ, Schonberger LB, et al. Kawasaki syndrome and factors associated with coronary artery abnormalities in california［J］. Pediatr Infect Dis J, 2012, 31(9): 894-898.
［8］Belay ED, Maddox RA, Holman RC, Curns AT, Ballah K, Schonberger LB. Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003［J］. Pediatr Infect Dis J, 2006, 25(3): 245-249.
［9］Rosenfeld EA, Corydon KE, Shulman ST. Kawasaki disease in infants less than one year of age［J］. J Pediatr, 1995, 126(4): 524-529.
［10］Cai Z, Zuo R, Liu Y. Characteristics of Kawasaki disease in older children［J］. Clin Pediatr (Phila), 2011, 50(10): 952-956.
［11］高天霁. 姑表兄弟同患川崎病2例报道［J］. 中国当代儿科杂志，2012，14（4）：314-315.
［12］Song D, Yeo Y, Ha K, Jang G, Lee J, Lee K, et al. Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age［J］. Eur J Pediatr, 2009, 168(11): 1315-1321.
［13］Kim JJ, Hong YM, Yun SW, Han MK, Lee KY, Song MS, et al. Assessment of risk factors for Korean children with Kawasaki disease［J］. Pediatr Cardiol, 2012, 33(4): 513-520.
［14］Burns JC, Glode MP. Kawasaki syndrome［J］. Lancet, 2004, 364(9433): 533-544.
［15］Tse SM, Silverman ED, McCrindle BW, Yeung RS. Early treatment with intravenous immunoglobulin in patients with Kawasaki disease［J］. J Pediatr, 2002, 140(4): 450-455.
［16］Muta H, Ishii M, Egami K, Furui J, Sugahara Y, Akagi T, et al. Early intravenous gamma-globulin treatment for Kawasaki disease: the nationwide surveys in Japan［J］. J Pediatr, 2004, 144(4): 496-499.
［17］Chiyonobu T, Yoshihara T, Mori K, Ishida H, Nishimura Y, Yamamoto Y, et al. Early intravenous gamma globulin retreatment for refractory Kawasaki disease［J］. Clin Pediatr (Phila), 2003, 42(3): 269-272.
［18］张倩，项如莲. 静脉注射丙种球蛋白无反应型川崎病的诊治进展［J］. 中国当代儿科杂志，2009，11（4）：318-321.
［19］Son MB, Newburger JW. Management of Kawasaki disease: corticosteroids revisited［J］. Lancet, 2012, 379(9826): 1571-1572.
PDF(1063 KB)
