Risk Factors For Coronary Artery Damage In Children With Kawasaki Disease

Background:Kawasaki disease（KD）is an acute autoimmune vasculitis,characterized by bilateral conjunctivitis and atypical rash,the majority of the patients were children,with more males than females.The etiology of this disease is still unclear,and most people believe that KD is an immune-mediated vasculitis syndrome.It has been reported that the incidence of KD has significant ethnic and regional differences,which is reflected in the high incidence in Asia and low incidence in Europe and America^[1].At present,KD has replaced rheumatic fever as an important cause of children’s acquired heart disease.According to the statistics of untreated children with KD coronary artery damage（coronary artery lesions,CAL）incidence can be as high as l5%to 25%^[2].Studies have shown that even with high doses of gamma globulin and aspirin standard therapy in children with KD,there are still 5%of children will appear Coronary artery expansion（Coronary artery dilation,CAD）,1%of children will appear coronary move affectionately tumor（coronary artery aneurysms.CAA）.Even some children will have serious adverse cardiovascular events such as myocardial infarction or sudden death^[3-4].Therefore,to explore the risk factors of KD complicated with CAL can provide a reliable basis for preventing the complicated CAL in children with KD and reducing its incidence.Objective:To investigate the risk factors of coronary artery damage in children with kawasaki disease.Materials and methods:The clinical data of 245 children with KD admitted to the department of pediatrics of shandong provincial hospital from January 2016 to December2018 were retrospectively analyzed.The factors that may affect the complication of KD with CAL and CAA with KD are as follows:Age,gender,acrylic ball resistance,delay treatment,duration of fever,white blood cell count（WBC）,neutrophil absolute value（NEUT#）,neutrophil percentage（NEUT%）,lymphocyte absolute value（LYMPH#）,lymphocyte percentage（LYMPH%）,platelet count（PLT）,platelet distribution width（PDW）,mean platelet volume（PMV）,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,alanine aminotransferase（ALT）,albumin（propagated）,total bile acid（associates）,serum sodium（Na）of blood and other single first Factor analysis and further multi-factor analysis of the risk factors of KD complicated with CAL and KD complicated with CAA.Results:（1）The number of male children with KD is about 1.3 times that of female children,and the incidence of CAL in children younger than 1 year old is 1.83 times that of children older than 1 year old.（2）Among 245 cases of KD,71 cases had CAL,and the rate of coronary artery injury was 28.9%.（3）Univariate analysis showed that age,gender,duration of fever,delayed treatment,ball resistance,PLT,WBC,ESR,CRP and ALB may be related to the occurrence of CAL（P<0.05）,multivariate Logistic regression analysis showed that delayed treatment,ball resistance,PLT and WBC were related to the occurrence of CAL（P<0.05）.（4）Univariate analysis showed that age,ball resistance,duration of fever,PLT and ESR might be associated with CAA in children with KD（P<0.05）,the results of multivariate Logistic regression analysis showed that ESR and duration of fever>10d were associated with CAA in children with KD（P<0.05）.Conclusions:（1）The complication rate of CAL is high in young male children with KD.（2）Ball resistance,delayed treatment,high level of ALB and elevated WBC are risk factors for the occurrence of CAL in KD.（3）Elevated ESR and duration of fever>10 d are risk factors for CAA in children with KD.（4）Color doppler echocardiography can observe the degree and outcome of coronary artery lesions in real time,which is helpful for the early diagnosis and long-term follow-up of KD.