| Objective: To analyze the clinical characteristics of Kawasaki disease(KD)and coronary artery lesions(CALs)from the aspects of sex,age,essential clinical manifestations,cardiac damage,and admission laboratory indicators,and to explore the extent of coronary artery lesions under different conditions by combining the absolute value of coronary artery diameter measured by echocardiography and the Z value corrected by body surface area;The follow-up of KD children was summarized to understand the change of the condition,quantitatively analyze the changing trend of Z value of each coronary artery under different treatment methods,and explore the outcome of the disease,in order to provide a reference basis for the diagnosis,treatment,follow-up,and management of KD children with CALs.Methods: A retrospective study of 524 children who attended the Second Hospital of Lanzhou University from January 2017 to December 2021 with a confirmed diagnosis of KD and met exclusion criteria was conducted to collect clinical data at the time of initial admission for diagnosis of KD and during follow-up,including(1)basic information: age,sex,admission date,and onset date;(2)clinical manifestations;(3)routine blood-related indicators at admission,such as white blood cell count(WBC),percent immature granulocytes(IG),hemoglobin(Hb),platelet count(PLT),mean platelet volume(MPV),etc.,sedimentation(ESR),C-reactive protein(CRP),albumin(ALB),ghrelin(ALT),and glutamate transaminase(AST)at the time of initial admission for diagnosis of KD and during the follow-up;(4)ECG results at the time of initial admission for diagnosis of KD and during follow-up,cardiac ultrasound and coronary ultrasound findings at the time of initial admission for diagnosis of KD and during follow-up,including the absolute values of the internal diameters of the left coronary artery trunk(LMCA),right coronary artery(RCA),left anterior descending branch(LAD)and gyrus branch(LCX)and the Z value corrected for body surface area;(5)treatment status.The above data were analyzed using SPSS 26.0 software to explore the basic clinical characteristics and disease regression in children with KD complicated with CALs.Results:(1)General clinical data: A total of 524 children with KD were included in this study,and a total of 274(52.3%)presented CALs in the acute phase,including 199(72.6%)with coronary artery dilation(CAD)and those who showed only transient dilation,and 75(27.4%)with coronary artery aneurysm(CAA),with the risk level of complicating CAD involving the coronary arteries LMCA> LAD>RCA>LCX,and the risk of concomitant CAA involving coronary arteries was LAD>LMCA>RCA>LCX.(2)Comparison of gender relationship: Of the children with KD included in this study,341(65.1%)were male and 183(34.9%)were female,with a male to female ratio of approximately 1.86:1;the risk of CAA was higher in men than in women(P<0.05),and the absolute value and Z value of the mean internal diameter of each branch of coronary artery of LMCA,LAD,RCA and LCX were higher in men than in women,but there was no statistically significant difference in the quantitative comparison of the absolute value and Z value of the mean internal diameter of each coronary artery in men and women(P>0.05).(3)Comparison of age relationship: In this study,the age of onset of KD was concentrated in early childhood,with a total of 268 cases(51.1%),and the median age of onset was 25(15,41)months.the risk of CAA development in the infant group was higher than that in the toddler group,preschool,school age and late school age groups(P<0.05),the extent of lesions in the LMCA and LAD coronary artery groups in the infant group was greater than that in the other coronary artery groups(P<0.05),and the mean values of absolute coronary internal diameter and quantitative comparison of Z values in the RCA and LCX groups in the infant group were higher than those in the other groups,but the differences were not statistically significant(P>0.05).(4)Comparison of the relationship between different types of KD: There was no statistically significant difference in the incidence risk of CAA between the c KD group and the i KD group in this study(P>0.05),but the quantitative analysis of Z value showed that the degree of coronary artery lesions of RCA and LAD in the i KD group was greater than that in the c KD group(P<0.05).(5)Non-coronary artery cardiac abnormalities: Among 274 children with CALs,50(18.2%)had pericardial effusion,45(16.4%)had cardiac enlargement,3(1.1%)had decreased cardiac function,9(3.3%)had increased pulmonary artery pressure,and 12(4.4%)had myocarditis in the acute phase.The acute ECG showed sinus tachycardia in 157 cases(57.3%),sinus arrhythmia in 7 cases(2.6%),atrioventricular block in 12 cases(4.3%),T-wave changes in 9 cases(3.3%),atrial asystole in 19 cases(6.9%),and ventricular asystole in 8 cases(2.9%);the above non-coronary cardiac abnormalities were found in more than 90% of cases during follow-up.More than90% of the above non-coronary cardiac abnormalities could be recovered within 3months of the disease course during the follow-up,and no significant abnormalities were found in the later follow-up.(6)Comparison of laboratory tests: WBC,IG,CRP,ALB and CK-MB levels were higher in the CAL group than in the non-CAL group,and the difference was statistically significant(P<0.05);PLT,MPV,ESR and AST were all increased to different degrees in the CAL and non-CAL groups,but the difference between the two groups was not statistically significant(P>0.05).(7)Follow-up: The follow-up rate of KD increased year by year,and the follow-up rate of children with CAL was higher than that of the non-CALs group;256(93.5%)of 274 children with CALs presenting in the acute phase recovered at 1 year of disease;65 children with small and medium-sized CAA recovered at 2 years of disease,and 4 of 10 children with giant CAA still did not recover at 2 years of disease;the 7 cases that formed appendage thrombosis in this study All of the children in this study were in the giant CAA group,and because of the short follow-up period,no children developed serious cardiovascular damage such as myocardial infarction and heart failure for the time being.(8)Comparison of different treatments: compared with aspirin + IVIG,the Z value of LMCA was lower in the aspirin + IVIG + hormone group at 2 months of disease and 1 month of disease,and the difference was statistically significant(P<0.05),but the difference in Z value at 3 months of disease and 6 months of disease was not statistically significant(P>0.05),and there was no significant difference in Z value in other coronary branches during the treatment and follow-up(P >0.05).Conclusion:(1)Among children with KD,the proportion of males,early childhood,and clinical presentation of c KD was higher than that of females,other age groups,and clinical presentation of i KD,but the severity of CALs occurred in males,infants,and children with i KD was higher than that of females,other age groups,and children with c KD;coronary artery damage was more likely to involve LMCA in children with CAD,and coronary artery damage was more likely to involve LAD in children with CAA.Non-coronary cardiac anomalies are almost universal in acute KD,but have less significance on the regression of KD.(2)The follow-up rate of children with KD seen in our hospital has been increasing year by year,with more than 50.0% of children developing CALs in the acute phase,but the vast majority recover within 1 year of disease,and most small to medium-sized CAAs recover within 2 years of disease;more serious cardiovascular events may occur in the giant CAA group.(3)Glucocorticoids do not increase the risk of CALs,and LMCA in children with KD treated with glucocorticoids had improved better at 2 weeks of disease duration at 2 weeks and 1 month of disease. |
PDF Full Text Request