Analysis Of Clinical Characteristics And Risk Factors Of Developing Coronary Artery Lesions In 201 Children Hospitalized With Kawasaki Disease

Objective:To summarize and analyze the clinical characteristics of children with Kawasaki disease(KD)in different age groups,and explore the possible risk factors of coronary artery lesion(CAL)secondary to KD,and provide clue for the early diagnosis and treatment of KD and the identification of high-risk groups of CAL with KD.Method:201 patients of KD with complete clinical data between January 2011 and December 2018 at the General Hospital pediatrics of Tianjin Medical University were selected.According to the age at admission,they were divided into three groups :? 6months group,between 6 months to 5 years group,?5 years group.We used statistical methods to retrospectively analyze clinical characteristics in different age groups,including clinical manifestations,laboratory examinations and other aspects.According to the results of ultrasonic cardiogram,201 patients were divided into coronary artery lesion group(CAL group)and non-coronary artery lesion group(NCAL group).In addition,sex and age,clinical manifestations,laboratory examinations,and intravenous immune globulin(IVIG)treatment between the two groups were comparatively analyzed by statistical methods.Result:(1)The age of 201 KD patients was mainly distributed from 6 months to 5 years,of which 1 year was the peak age.More boys than girls,with a ratio of patients was1.96:1 male to female.The peak season for KD was summer.(2)The incidence of CAL in this study secondary to KD was 20.1 % and that of nonresponse to IVIG was 13.9 %.(3)The duration of fever,C-reactive protein(CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)before IVIG treatment were statistically different between the three groups.In the ?5 years group,duration of fever was the longest,and CRP was the highest.In the ? 6 months group NT-proBNP was the highest.(H values were 11.399,11.648,17.7601,P values were 0.003,0.003,0.000).(4)The incidence of changes in extremities,cervical lymphadenectasis,and BCGscar redness were statistically different between the three groups.In the 5 years group the incidence of changes in extremities,cervical lymphadenectasis were highest,and that of BCG scar redness was lowest.In the ?6 months group incidence of changes in extremities,cervical lymphadenectasis were lowest,and that of BCG scar redness was highest.(c2 values were 7.280,7.429,17.583,P values were 0.026,0.019,0.000).(5)The white blood cell(WBC)and platelet-to-lymphocyte ratio(PLR)before IVIG treatment were higher in CAL group than NCAL group with statistical difference.(Z values were-2.037,-2.005,P values were 0.042,0.040).(6)The incidence of IVIG non-responsiveness in CAL group was higher than NCAL group with statistical difference.(c2 values was 7.444,P values was 0.006).(7)Based on the Logistics binary regression analysis,the PLR value before IVIG treatment was independent risk factor for CAL with KD(P = 0.024).The odds ratio was 1.006.Their corresponding 95% confidence intervals was(1.001,1.012).(8)Using the ROC curve to find the PLR critical value,the result showed that the PLR =68.37 was the boundary point,best predicting the occurrence of CAL secondary to KD(P = 0.04<0.05).The sensitivity and the specificity were respectively 81% and42%.Conclusion:(1)BCG scar redness and increased NT-proBNP had great significance for early diagnosis of KD in 6 months or younger children.(2)IVIG non-responsive children with KD should be vigilance for the occurrence of CAL,while following their ultrasonic cardiogram closely.(3)The PLR value before IVIG treatment was independent risk factors for CAL.The PLR=68.37 was the boundary point best predicting the occurrence of CAL with KD.