中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (3): 225-228.

• 论著 • 上一篇    下一篇

川崎病延迟诊断的危险因素分析

花旺,郑风雷,陶怡静,王滢,龚方戚   

  1. 浙江大学医学院附属儿童医院,国家儿童健康与疾病临床医学研究中心  杭州,310052
  • 收稿日期:2020-10-29 修回日期:2021-06-25 出版日期:2021-06-25 发布日期:2021-06-25
  • 通讯作者: 龚方戚

Analysis of risk factors for delayed diagnosis of Kawasaki disease

HUA Wang, ZHENG Fenglei, TAO Yijing, WANG Ying, GONG Fangqi   

  1. Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
  • Received:2020-10-29 Revised:2021-06-25 Online:2021-06-25 Published:2021-06-25
  • Contact: GONG Fangqi

摘要: 背景:目前对川崎病(KD)尤其是不典型KD的及时诊断仍面临困难。 目的:分析KD患儿延迟诊断的影响因素。 设计:病例对照研究。 方法:采用日本川崎病研究委员会2005年发布的第5版KD诊断标准,6条主要诊断标准中满足≥5条即可诊断KD。纳入2009年1月至2014年12月在浙江大学医学院附属儿童医院住院的KD患儿,发病10 d后诊断KD者为延迟诊断组,反之为无延迟诊断组。截取患儿的一般信息、临床表现、总热程、发病后首次实验室检查结果、IVIG治疗后的第1次血常规等,在两组间比较的基础上行多因素logistic回归分析,危险因素的拟合优度检验采用Hosmer and Lemeshow检验。 主要结局指标:延迟诊断KD的影响因素。 结果:2 194例KD患儿中,男1 354例,女840例,发病月龄中位数21(11~43)个月,延迟诊断组168例,无延迟诊断组2 026例。延迟诊断组中男性、>5岁比例较高,总热程较长,入院时满足主要诊断标准数较少、不典型KD患儿比例较高; ALB、血钠较高,ALT、TBil、GGT较低;冠状动脉损伤和扩张的发生率较高;IVIG治疗前后CRP、N绝对值和%、N/L比例均较低;差异均有统计学意义。总热程≥10 d(OR=36.1,95%CI:9.7~133.8)是延迟诊断KD的危险因素,入院满足诊断标准数≥5个(OR=0.40,95%CI:0.29~0.54)是延迟诊断KD的保护因素。 结论:总热程≥10 d和入院满足主要诊断标准数<5个可能是KD延迟诊断的危险因素。

关键词: 川崎病, 延迟诊断, 危险因素

Abstract: Background: Timely diagnosis of Kawasaki disease (KD) still posed a big challenge especially for those presenting atypical forms. Objective: To analyze the risk factors for delayed diagnosis of KD. Design: Case-control study. Methods: KD diagnostic criteria of Kawasaki Disease Research Committee of Japan (5th Edition, 2005) were adopted. KD can be diagnosed if more than 5 of the 6 main diagnostic criteria are met. KD inpatients were enrolled from Children's Hospital of Zhejiang University Medical College from January 2009 to Decemeber 2014. Patients diagnosed with KD more than 10 days after onset were included in the delayed diagnosis group, otherwise they were included in the non-delayed diagnosis group. The demographic features, clinical manifestations, total fever duration, the first laboratory examination results, and the first routine blood test after IVIG treatment were collected. Risk factors were established by univariate analysis and multivariate logistic regression analysis. Hosmer and Lemeshow test was used to test the goodness of the fit of risk factors. Main outcome measures: Risk factors for delayed diagnosis of KD. Results: There were 1,354 males and 840 females in 2,194 children with KD. The median age of onset was 21 (11-43) months. There were 168 cases enrolled in delayed diagnosis group. Compared with the non-delayed diagnosis group, the proportion of male and > 5 years old in the delayed diagnosis group were higher, the total fever duration was longer, the number of children who met the main diagnostic criteria was less, and the proportion of atypical KD children was higher, the levels of ALB and serum sodium were higher,the levels of ALT, TBiL and GGT were lower, the incidence of coronary artery injury was higher, the level of CRP, the absolute value and percentage of neutrophil and NLR before and after IVIG treatment were lower. The differences were statistically significant. The OR values of the total fever duration ≥10 days was 36.1(95% CI: 9.7-133.8), and the OR value of the cases meeting main diagnostic criteria was 0.40(95%CI:0.29~0.54). Conclusion: The risk factors for delayed diagnosis of KD were that the total fever duration was more than ten days and the number of main diagnostic criteria was less than five.

Key words: Kawasaki disease, Delayed diagnosis, Risk factor