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目的探讨川崎病(KD)患儿合并冠状动脉损伤的危险因素。方法按照KD诊断标准,对北京儿童医院2000-01-01—2004-12-31收治的644例KD患儿临床资料、治疗方法以及实验室资料进行分析。结果Pear-son卡方检验显示,患儿性别、发热持续时间、丙种球蛋白使用时间、丙种球蛋白使用剂量、血沉及C反应蛋白与KD合并冠状动脉损伤有关(P<0·05);进一步多因素Logistic回归分析显示,性别、发热持续时间、丙种球蛋白使用剂量与冠状动脉扩张显著独立相关(P<0·05)。结论对男性、发热持续时间长的KD患儿应予足够重视,早期足量使用丙种球蛋白以减少或减轻冠状动脉并发症。

Risk factors of coronary lesions in children with Kawasaki disease

Objective To summarize the clinical pictures and laboratory study results of children with Kawasaki disease,and further analyze the risk factors of coronary complications in Kawasaki disease.Methods All charts of consecutive children with a diagnosis or suspicious diagnosis of Kawasaki disease from January 1,2000 to December 31,2004 were reviewed retrospectively.Children with clinical pictures satisfied to the 5th revision of diagnostic criteria of Kawasaki disease were included.Patients gender,age,duration of fever,use of intravenous gamma immunoglobublin (IVIG),corticosteriod use,laboratory study results,and echocardiographic study results were summarized.Chi-square test and logistic regression were performed to analyze the risk factors of coronary abnormalities.Results A total of 644 patients with Kawasaki disease were enrolled as the subjects of this study.Their age ranged from 1 month to 13.3 years of age,Laboratory study showed most of patients had elevation of ESR,C-reactive protein,WBC count,platelet count,while some of them had hypoalbuminemia and anemia.Out of all patients,644 had coronary dilation with an incidence of 36.3%.Coronary aneurysm was identified in 16 patients with an incidence of 2.5%.Statistical analysis showed that gender,duration between onset and IVIG treatment,dosage of IVIG,duration of fever,ESR and CRP were related to coronary abnormalities(P<0.05).Multiple logistic regression identified that gender,duration of fever and dosage of IVIG were independent factors contributing to the development of coronary abnormalities.Conclusion Being male,longer duration of fever,duration between onset and IVIG treatment and IVIG dosage,ESR and CRP are independent risk factors contributing to the development of coronary abnormalities.