儿童重症监护室收治的川崎病临床特征及高危因素分析

黄奇; 肖曙芳; 王艳俊; 李斌; 董芳玲

doi:10.13201/j.issn.1009-5918.2021.11.007

儿童重症监护室收治的川崎病临床特征及高危因素分析

- 昆明医科大学附属儿童医院儿童重症监护病房(昆明, 650100)

详细信息

通讯作者: 肖曙芳,E-mail:xiaoshufang@etyy.cn

中图分类号: R725.4

收稿日期: 2021-07-09

Analysis of the clinical characteristics and high risk factors of Kawasaki disease treated in pediatric intensive care unit

- Department of PICU, Children's Hospital Affiliated to Kunming Medical University, Kunming, 650100, China

More Information

Corresponding author: XIAO Shufang, E-mail: xiaoshufang@etyy.cn

Received Date: 09 July 2021

摘要

摘要: 目的:分析收住儿童重症监护室(PICU)的川崎病(KD)患儿相关临床特征,探究KD患儿收住PICU的高危因素。方法:选择昆明医科大学附属儿童医院收住PICU的KD患儿33例,与同期未收住PICU的普通组KD患儿87例进行比较,分析两组患儿临床特征及辅助检查指标差异,并采用多因素分析及ROC曲线分析KD患儿入住PICU的高危因素。结果:PICU组患儿各脏器影像检查异常率高于普通组,心脏冠脉异常率分别为51.5%、26.4%(P=0.009),心脏扩大发生率分别为12.1%、0(P=0.006),差异均有统计学意义。PICU组患儿更容易出现腹痛、皮肤黄染、腹泻、首诊时更常表现为不典型KD(典型KD发生率分别为27.3%,54.0%,P=0.009),抗生素使用率、免疫球蛋白(IVIG)无反应发生率(18.2%,3.5%,P=0.019)亦更高。PICU组患儿白细胞、中性粒细胞比例(N%)、C反应蛋白(CRP)、降钙素原(PCT)、谷草转氨酶、胆红素、胆汁酸、血肌酐、尿素氮更高,血红蛋白(Hb)、血小板、白蛋白、血清钠较普通组更低(P<0.05),多因素Logistic回归分析提示KD患儿N% ≥ 76.7%(AUC:0.869,95%CI:0.802~0.936)、Hb ≤ 102 g/L(AUC:0.905,95%CI:0.834~0.975)、Na⁺ ≤ 132.85 mmol/L(AUC:0.813,95%CI:0.730~0.895)是入住PICU的高危因素,敏感度和特异度分别为:0.879,0.701;0.788,0.920;0.545,0.931。结论:①中性粒细胞升高、血红蛋白降低、血清钠降低是KD的高危因素,建议早期重症监护治疗;②KD高危患儿更易出现IVIG无反应、合并冠脉异常及心脏扩大,早期识别及定期随访超声心动图对KD的诊治有重要的临床意义。
- 川崎病 /
- 重症监护 /
- 临床特征 /
- 高危因素 /
- ROC分析
Abstract: Objective:To analyze the clinical characteristics of Kawasaki disease(KD) in children admitted to PICU, and to explore the risk factors of KD children admitted to PICU.Methods:33 KD children admitted to the Children's Hospital affiliated to Kunming Medical University were compared with 87 KD children not admitted to PICU in the same period. The differences in clinical characteristics and auxiliary examination indexes between the two groups were analyzed, and the high risk factors of KD children admitted to PICU were analyzed by using multi-factor analysis and ROC curve.Results:The abnormal rate of each organ imaging in the PICU group was higher than that in the general group, the abnormal rate of coronary artery(51.5%, 26.4%, P=0.009) and the incidence of cardiac enlargement(12.1%, 0%, P=0.006) were statistically significant. In the PICU group, children were more likely to have abdominal pain, yellow skin, diarrhea, and atypical KD(typical KD incidence was 27.3%, 54.0%, P=0.009, respectively), and antibiotic utilization rate and immunoglobulin(IVIG) non-response rate were also higher(18.2%, 3.5%, P=0.019). PICU group had higher WBC, neutrophilic granulocyte ratio(N%), C-reactive protein(CRP), procalcitonin(PCT), alanine aminotransferase, bilirubin, bile acid, serum creatinine, urea nitrogen, and lower hemoglobin(Hb), platelet, albumin, and serum sodium than the normal group(P<0.05). Multivariate Logistic regression analysis indicated that N% ≥ 76.7%(AUC:0.869, 95%CI:0.802~0.936), Hb ≤ 102 g/L(AUC:0.905, 95%CI:0.834~0.975), Na⁺ ≤ 132.85 mmol/L(AUC:0.813, 95%CI:0.730~0.895) were the high risk factors for PICU admission. The sensitivity and specificity were 0.879 and 0.701, respectively. 0.788, 0.920; 0.545, 0.931.Conclusion:(1)Elevated neutrophils, decreased hemoglobin and decreased serum sodium are the high risk factors of KD. Early intensive care treatment is recommended.(2)KD high-risk children are more likely to have IVIG non-response, complicated with coronary artery abnormalities and heart enlargement. Early identification and regular follow-up echocardiography have important clinical significance for the diagnosis and treatment of KD.
- Kawasaki disease /
- intensive care /
- clinical features /
- high risk factors /
- ROC analysis

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