Analysis On Coronary Artery Lesions With Kawasaki Disease

Objective: To investigate the high risk factors for coronary artery aneurysms(CAA)complicated with Kawasaki disease(KD)for inpatient children.And to compare coronary artery lesions(CAL)between intravenous immunoglobulin(IVIG)resistant KD and sensitive KD based on Z scores.Methods: 1.Totally 679 inpatient children with KD from January 2005 to December 2011 in our hospital were enrolled in this study.These data was analyzed by Chi-square test,to analyze the possible risk factors for CAA that was performed by multiple Logistic regression analysis.2.Totally 87 inpatient children with KD from January 2018 to July 2018 in our hospital were enrolled,including complete height and weight data.These data was calculated by Z scores which corrected by body surface area and analyzed by SPSS.Results:1.There were 32 cases(4.71%)of CAA in 679 cases,including 8 cases resistant to intravenous immunoglobulin(IVIG).In total 32 cases of CAA,25 cases treated by one to three times of 2 g/(kg· time)IVIG,including 2 cases also treated by methylprednisolone.The other 7 cases of CAA treated by four to seven times of less than or equal 1 g/(kg· time)IVIG.There were 6 recurrent KD cases(0.88%),occurred on the 2nd-18 th m after the onset of the illness,including one case complicated with CAA.There was no death case during the acute stage.2.In total 87 cases,there were 43 cases(72.89%)of CAL among 59 cases that were sensitive to IVIG,including 12 cases(27.90%)of coronary artery dilation,27 cases(62.79%)of small CAA,4 cases(9.30%)of medium-sized CAA or giant CAA.There were 24 cases(85.71%)of CAL among 28 cases that resistant to IVIG,including 1 case(4.17%)of coronary artery dilation,15 cases(62.50%)of small CAA,and 8 cases(33.3%)of medium-sized CAA or giant CAA.A total of 173 cases with the acute,subacute and convalescent stage were evaluated by Z score,with a sensitivity of 97.8%(90/92)and a specificity of 50.6%(41/81).3.The results showed that male,duration of fever ? 10 d,time of treatment of IVIG ? the 7th day of fever,hemoglobin < 100 g/L,erythrocyte sedimentation rate > 100 mm/h,serum albumin < 30 g/L were associated with complicated CAA(P <0.05).4.The results analyzed by multiple Logistic regression analysis showed that hemoglobin < 100 g/L [OR=2.99,95%CI(1.01,8.75),P =0.04],duration of fever ? 10 d [OR=6.67,95%CI(1.57,22.54),P=0.01],time of treatment of IVIG ? the 7th day of fever [OR=3.57,95%CI(1.12,11.02),P=0.02] were the independent risk factors for CAA.5.The difference of CAL incidence between IVIG-resistant KD and IVIG-sensitive KD was not statistically significant(P>0.05).In the acute stage,the difference of Z scores between IVIG-resistant KD(3.64±1.76)and IVIG-sensitive KD(3.12±1.28)was not statistically significant(P>0.05).In the non-acute stage,the difference of Z scores between IVIG-resistant KD(5.47±3.11)and IVIG-sensitive KD(3.42±1.90)was statistically significant(P <0.05).Among the cases sensitive to IVIG,the difference of Z scores between the acute stage(3.12±1.28)and the non-acute stage(3.42±1.90)was not significantly different(P>0.05).Among the cases resistant to IVIG,the difference of Z scores between the acute stage(3.64±1.76)and the non-acute stage(5.47±3.11)was significantly different(P <0.05).Conclusion: The factors of hemoglobin < 100 g/L,duration of fever ? 10 d and time of treatment of IVIG ? the 7th day of fever,were the independent risk factors of CAA.Z score was high sensitivity in evaluating CAL.Based on Z scores,in the non-acute stage,the severity of CAL with IVIG-resistant KD was more significant than that in the acute stage,and also more significant than IVIG-sensitive KD.