The Characteristics of Echocardiography in Acute Incomplete Kawasaki Disease among Infants and Young Children in Yunnan Province
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摘要:
目的 分析云南省婴幼儿不完全性川崎病（incomplete kawasaki disease，IKD）急性期超声心动图特征以及冠脉扩张的危险因素。 方法 选取昆明市儿童医院2017年4月至2019年4月收治住院的291例3岁以下川崎病患儿，其中113例IKD患儿，179例完全性川崎病（complete kawasaki disease，CKD）患儿，对其进行回顾性对比分析。2组患儿均行超声心动图检查，对比2组动脉内径、Z值、舒张期峰值血流速度（peak diastolic velocity，PDV）和平均血流速度（mean diastolic velocity，MDV）。根据患儿是否发生冠状动脉扩张，单因素、多因素Logistic分析冠状动脉扩张的危险因素。 结果 （1）IKD组患儿合并冠状动脉损伤较CKD组严重（P < 0.05），且年龄越小，合并冠状动脉损伤越严重；2组合并冠脉扩张患儿前降支PDV与MDV差异无统计学意义（P > 0.05）；2组冠脉内径Z值，差异有统计学意义（P < 0.05）；（2）Logistic多因素回归分析IKD冠状动脉扩张的潜在危险因素，多变量线性回归分析显示：持续发热时间≥5 d（OR = 1.408，P = 0.006）、C反应蛋白水平≥0.8 ng/L（OR = 1.396，P = 0.003）、白细胞计数≥20×109/L（OR = 1.382，P = 0.002）、血清白蛋白≥135 g/L（OR = 1.867，P = 0.004）是冠状动脉扩张的独立危险因素，P < 0.05。 结论 不完全性川崎病婴幼儿发病率高，临床表现不明显，易导致病情延误，应当引起临床重视。Z值可以客观评价冠状动脉损害程度。且年龄越小，冠状动脉损伤越严重，超声心动图对早期诊断冠脉病变及治疗后效果评估有重要意义。 Abstract:Objective To the echocardiography characteristics and the risk factors of coronary artery dilation among the infants with incomplete kawasaki disease （IKD） in Yunnan Province. Methoded A total of 291 children with Kawasaki disease under 3 years were studied retrospectively, All of them were treated in the Kunming Childrens’ Hospital from April 2017 to April 2019, including 113 children with IKD and 179 children with complete kawasaki disease （CKD）, All the children were examined by echocardiography, and the coronary aortic diameter, Z value and the peak diastolic flow velocity （PDV）, mean diastolic flow velocity （MDV） of the two groups were compared. In a way to whether the patient had the coronary artery dilation, risk factors on the coronary artery dilation by single factor and multi factors were analyzed with the logistic regression. Resulted 1. The IKD group with the coronary artery injury was more serious than that in the CKD group （P < 0.05）, and the younger the child, the more severe with coronary artery; There were no significant differences of PDV and MDV between the two groups with the coronary artery dilation （P > 0.05）. The difference in the Z value of the coronary artery diameter between the two groups was statistically significant （P < 0.05） ; 2. The potential risk factors for atypical KD coronary artery dilation were analyzed with the logistic regression. Multivariate linear regression analysis showed that: duration of fever ≥5 d （OR = 1.408, P = 0.006）, C-reactive protein level ≥0.8 ng/L （OR = 1.396, P = 0.003）, white blood cell count ≥20×109/L （OR = 1.382, P = 0.002）, serum albumin ≥135 g/L （OR = 1.867, P = 0.004） were the independent risk factors for the coronary artery dilation, P < 0.05. Conclusion Incomplete Kawasaki disease has a high incidence in infants and young children, and the clinical manifestations are not obvious, which can easily lead to the delay in the disease. It should be taken attention of clinicians. And the younger the age, the worse the coronary artery damage, and echocardiography has the great significance for the early diagnosis of coronary artery disease, Z value can objectively evaluate the damage of coronary artery and the evaluation of the effect after the treatment. -
Key words:
- Yunnan Province /
- Infants and young children /
- IKD /
- Acute phase /
- Echocardiography
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表 1 对比两组急性期冠脉损伤内径、冠脉内径Z值（
$\bar x \pm s$ ）Table 1. Compare the inner diameter of coronary artery injury and the Z value of coronary artery inner diameter in the acute phase between the two groups （
$\bar x \pm s $ ）组别 LMCA（mm） LAD（mm） pRCA（mm） ZLMCA ZLAD ZpRCA PDV（mm/s） MDV（mm/s） IKD（n = 45） 3.13 ± 0.52 2.51 ± 0.16 2.56 ± 0.26 0.57 ± 0.19 0.43 ± 0.13 0.65 ± 0.22 43.2 ± 0.12 26.3 ± 0.04 CKD（n = 92） 2.80 ± 0.11 2.29 ± 0.10 2.25 ± 0.11 −0.13 ± 0.11 −0.25 ± 0.05 0.19 ± 0.10 42.4 ± 0.13 27.3 ± 0.04 t 8.1906 14.4393 14.0585 31.8841 48.8212 24.2449 0.418 0.520 P 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.518 0.532 
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表 2 IKD与CKD冠状动脉损伤比较[n（%）]
Table 2. Comparison of coronary artery injury in IKD and CKD [n（%）]
组别 IKD（n = 45） CKD（n = 92） 最小年龄（月） 2 9 小瘤 32（70） 54（59） 中瘤 5（11） 29（22） 巨大瘤 8（18） 9（0.7） 血栓形成 9（20） 12（13）
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表 3 单因素分析冠状动脉扩张的危险因素
Table 3. Univariate analysis of risk factors for coronary artery dilation
组别 冠状动脉扩张（n = 45） 冠状动脉未扩张（n = 68） χ2 P 年龄（岁） < 1 20 36 0.7821 0.3765 ≥1 25 32 性别 男61 25 36 0.0363 08488 女52 22 30 发热时间（d） ≤5 11 42 15.1447 0.0000 > 5 34 26 C反应蛋白水平（ng/L） ≤0.8 13 51 7.9638 0.0048 > 0.8 32 17 丙种球蛋白治疗时间（d） ≥10 20 39 1.8084 0.1787 < 10 25 29 白细胞计数（×109
/L）≥20 31 24 12.2336 0.0005 < 20 14 44 使用激素 是 26 43 0.3392 0.5603 否 19 25 血钠（mmol/L） ≥135 31 32 5.2312 0.0222 < 135 14 36 血清白蛋白（g/L） ≥135 10 51 30.3647 0.0000 < 135 35 17
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表 4 冠状动脉扩张的危险因素赋值
Table 4. Risk factor assignment for coronary artery dilation
变量 赋值 X1 发热后就诊时间 < 10 = 0，≥10 = 1 X2 C反应蛋白水平 < 0.8 = 0，≥0.8 = 1 X3 白细胞计数 < 20 = 0，≥20 = 1 X4 血钠水平 < 135 = 0，≥135 = 1 X5 血清白蛋白 < 135 = 0，≥135 = 1
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表 5 多因素分析冠状动脉扩张的危险因素
Table 5. Multifactorial analysis of risk factors for coronary artery dilation
因素 Wald P OR 95%CI 持续发热时间 4.586 0.006 1.408 1.091～3.462 C反应蛋白水平 4.592 0.003 1.396 1.024～4.468 白细胞计数 4.568 0.002 1.382 1.011～3.485 血清白蛋白 4.628 0.004 1.408 1.328～3.458
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