2020 年第 12 期 第 15 卷

川崎病患儿冠状动脉病变的临床特征及其风险预测指标评价

Clinical characteristics and evaluation of risk predictive index of coronary artery disease in children with Kawasaki disease

作者：张英谦王华李亚楠王莹雪马翠胡阳

英文作者：Zhang Yingqian Wang Hua Li Yanan Wang Yingxue Ma Cui Hu Yang

单位：河北省儿童医院心内科，石家庄050031

英文单位：Department of Cardiology Hebei Children′s Hospital Shijiazhuang 050031 China

关键词：川崎病；冠状动脉病变；临床特征；预测指标；高危因素

英文关键词：Kawasakidisease;Coronaryarteriallesions;Clinicalfeatures;Predictiveindex;Highriskfactor

• 摘要：

• 目的  分析川崎病合并冠状动脉病变（CAL）的临床特征，探寻相关高危因素及预测指标。方法 收集2016年1月至2019年12月于河北省儿童医院住院的694例川崎病患儿的临床资料进行回顾性分析；根据冠状动脉是否扩张将其分为CAL组（110例）与无CAL组（584例）。分析川崎病患儿发生CAL的相关高危因素；对比国内外常用评分系统，筛选更适合预测CAL发生的可靠指标并评估其实用价值。结果本研究川崎病患儿CAL发生率为15.9%（110/694）。多因素Logistic回归分析结果显示PLT≥530×109/L（比值比=2.306，95%置信区间：1.244～4.276，P=0.008）、ESR≥75 mm/1 h（比值比=2.036，95%置信区间：1.180～3.511，P=0.011）为川崎病患儿CAL发生的独立危险因素。通过对以上实验室指标进行受试者工作特征曲线绘制，得出血红蛋白<109.5 g/L预测CAL的敏感度为58.49%，特异度为59.45%；PLT>407.5×109/L预测CAL的敏感度为61.11%，特异度为61.32%；ESR＞44.5 mm/1 h预测CAL的敏感度为60.60%，特异度为52.17%；白蛋白<35 g/L预测CAL的敏感度为52.69%，特异度为61.09%。结论 PLT≥530×109/L、血红蛋白≤100 g/L、ESR≥75 mm/1 h、白蛋白≤35 g/L对CAL发生有一定预测价值，白蛋白预测CAL临界值与以往常用的评分系统中≤35 g/L一致，PLT对CAL预测价值最高，但效能较低。

• Objective To analyze the clinical features and laboratory tests of Kawasaki disease complicated with coronary artery lesions (CAL), and to explore the related high-risk factors. Methods The clinical data of 694 children with Kawasaki disease admitted to Hebei Children′s Hospital from January 2016 to December 2019 were collected and analyzed retrospectively. The patients were divided into CAL group(110 cases) with dilated coronary artery and non CAL group(584 cases) without dilated coronary artery. The reliable indicators for the prediction of CAL occurrence were screened among the commonly used scoring systems at home and abroad and evaluated its practical value. Results The incidence of CAL in children with Kawasaki disease was 15.9% (110/694) in this study. Multivariate Logistic regression analysis showed that platelet (PLT)≥530×109/L(odds ratio=2.306, 95% confidence interval: 1.244-4.276, P=0.008), erythrocyte sedimentation rate (ESR)≥75 mm/1 h(odds ratio=2.036, 95% confidence interval: 1.180-3.511, P=0.011) were independent risk factors for CAL in children with Kawasaki disease. The receiver operating characteristic curve of the laboratory examination showed that the sensitivity of hemoglobin <109.5 g/L to predict CAL was 58.49%, the specificity was 59.45%. The sensitivity of the PLT>407.5×109/L to predict CAL was 61.11%, the specificity was 61.32%. The sensitivity of ESR ＞44.5 mm/1 h to predict CAL was 60.60%, the specificity was 52.17%. The sensitivity of albumin<35 g/L to predict CAL was 52.69%, the specificity was 61.09%. ConclusionsPLT≥530×109/L, hemoglobin≤100 g/L, ESR≥75 mm/1 h, albumin≤35 g/L have certain predictive value for the occurrence of CAL in children with Kawasaki disease. The predicted CAL critical value of albumin≤35 g/L is consistent with the previous commonly used scoring system. PLT has the highest predictive value for CAL, but its effectiveness is low.