甘肃地区581例川崎病患儿流行病学特征分析

背景　川崎病（KD）是一种与冠状动脉病变（CAL）相关的系统性血管炎，可导致心肌病、心肌梗死甚至死亡。目前，KD发病率逐年攀升，已成为儿童获得性心脏病最常见的病因，显著影响成年后个体远期心血管疾病的发生。因此了解该病的流行病学特征以及影响因素对降低疾病发生率有重要意义。目的　从人口学特征、时间分布和地域差异三方面探讨KD在甘肃地区的流行病学特征，以期为西部地区KD的管理和预防提供科学依据。方法　选取2012-2019年兰州大学第二医院收治的581例KD患儿为研究对象，根据入选患儿1个月内CAL发生情况将其分为KD合并CAL组（CAL组）和无CAL组（NCAL组），根据发病年龄划分为≤1岁、>1~3岁、>3~6岁和>6岁4个年龄段。采用统一的调查表收集一般资料（年龄、性别、民族、发病时间等）、冠状动脉彩超结果。结果　（1）人口学特征：581例KD患儿的中位发病年龄为1.9（1.2，3.2）岁，男∶女为1.9∶1，男性患儿在KD人群中的发病比例随年龄的增长呈下降趋势（χ2趋势=5.100，P<0.05）。（2）时间分布：不同年份间KD病例数总体呈上升趋势（χ2趋势=122.348，P<0.001）；各季节患儿分布情况比较，差异有统计学意义（χ2=12.418，P=0.006）；春季患儿占比与年龄段呈负相关（rs=-1，P<0.001），而秋季患儿占比与年龄段呈正相关（rs=1，P<0.001）。（3）地域差异：结合甘肃地理位置、自然条件和区域经济社会发展现状，将甘肃省划分为河西、陇中、陇东、陇东南、民族五大区域；依据城镇居民日常生活开支、职工平均工资和社会经济发展水平等将甘肃省按发达程度由高到低划分为四类地区。陇中（χ2趋势=86.011，P<0.001）、陇东南（χ2趋势=23.848，P<0.001）和民族区域的KD病例数（χ2趋势=17.463，P<0.001）均逐年增加；一类（χ2趋势=54.551，P<0.001）、二类（χ2趋势=20.586，P<0.001）、三类（χ2趋势=14.844，P<0.001）和四类地区的KD病例数（χ2趋势=36.013，P<0.001）均逐年增加。（4）影响因素：不同年份间合并CAL（χ2趋势=95.041，P<0.001）和NCAL的KD病例数（χ2趋势=38.719，P<0.001）均呈上升趋势，尤以CAL组为著（χ 2趋势=9.502，P<0.05）；多因素Logistic回归分析结果显示，年龄〔OR=3.011，95%CI（1.313，6.907）〕、性别〔OR=1.634，95%CI（1.137，2.349）〕和四类地区〔OR=1.772，95%CI（1.172，2.679）〕是KD合并CAL的影响因素。结论　甘肃地区KD患病人数逐年增加，以CAL组KD患儿的增长为著，疾病负担严重，经济欠发达地区尤为明显，为降低KD及其并发症发生率，需要提高公众对疾病严重性的认识、在夏季对男性婴幼儿适当加大防治力度（尝试对KD高危人群提前干预，如免疫调节）、建立健全KD随访机制、加强基层医生培训、开展多中心研究并持续监测KD的流行病学特征以获取与最佳预防策略、早期诊断、治疗时机和治疗选择相关的重要信息。

Analysis of Epidemiological Characteristics of 581 Children with Kawasaki Disease in Gansu

Background　Kawasaki disease （KD） is a systemic vasculitis associated with coronary artery lesion （CAL），which can lead to cardiomyopathy，myocardial infarction and death. At present，the incidence of KD is increasing year by year and has become the most common cause of acquired heart disease in children，significantly affecting the occurrence of long-term cardiovascular events during adulthood. Understanding the epidemiological characteristics and influencing factors of the disease is of great significance for reducing the incidence of the disease. Objective　To discuss the epidemiological characteristics of KD in Gansu from three aspects：demographic characteristics，time distribution and regional differences，in order to provide scientific basis for the management and prevention of KD in the western region. Methods　The 581 children with KD admitted to the Lanzhou University Second Hospital from January 2012 to December 2019 were selected as the research objects. According to the CAL status of the selected children within 1 month，the children with KD were divided into KD combined with CAL （CAL group） and without CAL （NCAL group）. According to the age of onset，they were divided into four age groups：≤1 year old，>1-3 years old，>3-6 years old and >6 years old. A unified questionnaire was used to collect general information （age，gender，ethnicity，time of onset，etc.） and thecoronary artery color Doppler ultrasound results. Results　（1）Demographic characteristics：among the 581 hospitalized children，the median age of onset of KD was 1.9 （1.2，3.2）years old. The ratio of male to female was about 1.9∶1 and the proportion of males decreased linearly with the increase of age （χ2trend=5.100，P<0.05）. （2）Temporal distribution：the overall number of KD showed an upward trend in different years （χ2trend=122.348，P<0.001）. There were significant differences in the distribution of KD cases in each season（χ2=12.418，P<0.05）. The proportion of children in spring was negatively correlated with their age groups（rs=-1，P<0.001），of which in autumn was positively correlated with the age groups（rs=1，P<0.001）. （3）Regional differences：combined with the geographical location，natural conditions and the current situation of regional economic and social development，Gansu Province was divided into five regions：Hexi，Longzhong，Longdong，Longdongnan and ethnic regions. According to the daily living expenses of urban residents，the average wage of workers and the level of social and economic development，Gansu Province was divided into four types of economic areas from high to low. The number of medical cases increased year by year in Longzhong region（χ2trend=86.011，P<0.001），Longdongnan region （χ2trend=23.848，P<0.001） and ethnic region （χ2trend=17.463，P<0.001）. The number of medical cases in economic class one （χ2trend=54.551，P<0.001），economic class two （χ2trend=20.586，P<0.001），economic class three （χ2trend=14.844，P<0.001） and economic class four （χ2trend=36.013，P<0.001） increased year by year. （4）Influencing factors：the number of KD cases of combined CAL （χ2trend=95.041，P<0.001） and NCAL （χ2trend=38.719，P<0.001） between different years showed an upward trend，especially in the CAL group （χ2trend=9.502，P<0.05）；multivariate Logistic regression analysis showed that age〔OR=3.011，95%CI（1.313，6.907）〕，gender〔OR=1.634，95%CI （1.137，2.349 ）〕and four economic areas〔OR=1.772，95%CI（1.172，2.679）〕were the independent risk factors of CAL. Conclusion　The number of patients with KD in Gansu had a tendency of growth by year，especially in the CAL group.The burden of disease was severe，especially in economically underdeveloped areas. In order to reduce the incidence of KD and its complications，it is necessary to increase public awareness of the severity of the disease，and properly increase prevention and control efforts for male infants in summer （try to intervene in advance for people at high risk of KD，such as immune regulation），establish and improve the KD follow-up mechanism，strengthen the training of primary physicians，conducting multi-center research and continuously monitorthe epidemiological characteristics of KD to obtain important information related to the best prevention strategy，early diagnosis，treatment timing and treatment choice.