中国实用儿科杂志

中国实用儿科杂志

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川崎病冠状动脉病变严重程度临床分级及高危因素研究

时艳艳，刘芳，吴琳，马晓静，梁雪村，黄国英   

  1. 作者单位: 复旦大学附属儿科医院心血管中心，上海 201102
  • 出版日期:2014-09-02 发布日期:2014-09-04
  • 基金资助:

    上海市级医院新兴前沿技术联合攻关项目（SHDC12013106）;上海市级医院适宜技术联合开发推广应用项目 (SHDC12012236)

Clinical grading and risk factors of coronary arterial lesions in patients with Kawasaki disease.

SHI Yan-yan，LIU Fang，WU Lin，MA Xiao-jing，LIANG Xue-cun，HUANG Guo-ying.   

  1. Department of Cardiology，Children’s Hospital of Fudan University， Shanghai 201102， China
  • Online:2014-09-02 Published:2014-09-04

摘要：

目的 探讨基于临床分级的川崎病（KD）冠状动脉病变临床分级特点及不同危险等级冠状动脉病变的危险因素。方法 采用回顾性调查方法，对复旦大学附属儿科医院2000年1月至2011年6月住院且病史资料完整的1253例KD患儿，依据《川崎病冠状动脉病变的临床处理建议》提出的冠状动脉病变临床分级方法，分析冠状动脉病变临床分级及病变部位特点，采用单因素和多因素Logistic回归分析发生不同临床分级冠状动脉病变的危险因素。结果 （1）KD患儿急性期冠脉病变发生率为24.3%（304/1253）。根据冠状动脉病变临床分级进行分类，冠脉正常的Ⅰ级病例949例，占75.7%；Ⅱ级32例，发生率2.6%；Ⅲ级251例，发生率20.0%；Ⅳ级13例，发生率1.0%；Ⅴ级8例，发生率0.6%。（2）累及单支、双支、三支、四支冠状动脉者分别占冠状动脉病变患儿的42.4%、29.3%、16.1%和12.2%；发生病变的冠状动脉分支中左主干、左前降支、左回旋支、右冠状动脉病变分别占43.5 %、18.6%、6.8 %、31.1 %。（3）多因素Logistic回归分析显示，不完全型KD、CRP＞100 mg/L是Ⅱ级冠状动脉病变的独立危险因素；男性、年龄≤1岁、发热持续时间＞10 d、不完全型KD、ALB＜30 g/L是发生Ⅲ～Ⅴ级病变的独立危险因素。结论 （1）KD冠状动脉病变以Ⅲ级为最多见，占82.6%；V级最少见，占2.6%。（2）57.6%的冠状动脉病变累及二支或二支以上的冠状动脉。（3）KD冠状动脉病变部位以左冠状动脉主干最常见，其后依次为右冠状动脉、左前降支和左回旋支。（4）男性、年龄≤1岁、发热持续时间＞10 d、不完全型KD、ALB＜30 g/L是Ⅲ～Ⅴ级冠状动脉病变的独立危险因素。

关键词: 川崎病, 冠状动脉病变, 严重程度分级, 危险因素

Abstract:

Abstract： Objective To analyze the characteristics and risk factors of coronary artery lesions （CAL） in Kawasaki disease （KD） based on the clinical grading. Methods The clinical records of 1253 KD patients admitted to Children’s Hospital of Fudan university from January 2000 to June 2011 were analyzed retrospectively. Results （1）Coronary arterial lesions occurred in 304 cases with the incidence of 24.3% in KD patients. According to the clinical grading of CAL of KD， among 304 CAL patients， 32 cases （10.5%） were grade II，251 cases （82.6%） were grade Ⅲ， 13 cases （4.3%） were grade Ⅳ，and 8 cases（2.6%） were grade V， with the prevalence in KD patients of 2.6%，20.0%，1.0%，and 0.64% respectively. （2）In all CAL patients， single， double， three and four coronary branch lesions accounted for 42.4%， 29.3%，16.1% and 12.2% respectively. The lesions of left main trunk，left anterior descending branch，left circumflex branch and right coronary artery accounted for 43.5 %，18.6%，6.8 % and 31.1% of all the branches involved respectively. （3）The results of single factor analysis and multivariate logistic regression analysis showed that incomplete KD and elevated C reactive protein （＞100 mg/L） were the risk factors of grade Ⅱ CAL， while male sex， age younger than 1 year， duration of fever over 10 days， incomplete KD and low serum albumin （＜30 g/L） were the risk factors of Grade Ⅲ～ⅤCAL. Conclusions （1）Grade III CAL is the most common type in KD patients, accounting for 82.6% of CAL. （2）About 57.6% CAL occurs in two and abovetwo branches of coronary arteries. （3）The most frequently involved branch is left main trunk, followed by right coronary artery，left anterior descending branch and circumflex branch. （4）Being male， age＜1 year old， incomplete KD， long-lasting fever （＞10 d） and low serum albumin （＜30 g/L） are the independent risk factors of grade Ⅲ～ⅤCAL.

Key words: Kawasaki disease, coronary artery lesion, clinical grading, risk factor

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