川崎病并发冠状动脉扩张的高危因素探讨(附75例分析)

目的探讨川崎病(KD)并发冠状动脉扩张的危险因素,为临床早期诊断和治疗提供可靠依据。方法2001年1月~2004年12月我院儿科收治KD住院患儿75例,经心脏彩超检查分为两组:无冠状动脉扩张(nCAD)组37例和冠状动脉扩张(CAD)组38例。全部患儿测定血常规、血沉、C反应蛋白(CRP)、肝功能,检测T细胞亚群(CD3、CD4、CD8、CD4/CD8),记录发热天数,并对两组的检测结果进行对比。结果两组的发热时间、白细胞、血小板、血红蛋白、血沉、C反应蛋白、CD3、CD8、CD4/CD8及血清白蛋白水平均有显著性差异(P<0.05或P<0.01)。多因素Logistic回归分析提示急性期血小板、CRP、CD4/CD8明显增高与KD并CAD显著独立相关,而血红蛋白、CD8和血清白蛋白则为KD并CAD发生的保护因素。结论急性期可疑KD患者血小板、CRP、CD4/CD8增高或血红蛋白、CD8和血清白蛋白降低可作为川崎病并发冠状动脉扩张的早期预测因子。

Analyses on risk factors for coronary artery dilatation secondary to Kawasaki disease

Objective To investigate the risk factors on children with coronary artery dilatation(CAD)secondary to Kawasaki disease(KD)and to provide a clue for clinical diagnosis and treatment.Methods Clinical data were analyzed retrospectively in 75 patients with KD,including 37 cases without CAD(nCAD) and 38 cases with CAD.The duration of fever,mean value of platelets,erythrocyte sedimentation rate,C-reactive protein,hemoglobin,leukocyte,liver function and T-lymphocytes in nCAD were compared with those in CAD.Results The duration of fever,mean value of platelets,erythrocyte sedimentation rate,C-reactive protein,leukocyte,CD_4/CD_8 in CAD were higher than those in nCAD(P<0.05 or P<0.01),but hemoglobin,CD_3,CD_8,albumin in CAD were lower than those in nCAD(P<0.05 or P<0.01).Among the significant indexes,six ones were also significant in the multi-factor stepwise regression analysis(P<0.05).The results indicated that mean value of platelets(OR=1.010,95%CI=1.001-1.019),C-reactive protein(OR=1.039,95%CI=1.014-1.064)and CD_4/CD_8(OR=5.306,95%CI=1.007-27.948)were the risk factors of CAD secondary to KD,while the hemoglobin(OR=0.912,95%CI=0.842-0.989),CD_8(OR=0.711,95%CI=0.562-0.901)and albumin(OR=0.762,95%CI=0.612-0.949)were protective.Conclusion Mean value of platelets,C-reactive protein and CD_4/CD_8 are the risk factors of CAD secondary to KD,while the hemoglobin,CD_8 and albumin are protective.These factors may potentially be predictors of CAD in patients with KD.