CAJ | 학술논문

目的：分析川崎病休克综合征（KDSS）的临床特点及危险因素，以改善其预后。方法本研究纳入2009年1月至2013年12月在温州医科大学附属育英儿童医院诊断为KDSS的患儿8例（KDSS组），收集同一时期确诊为川崎病（血流动力学稳定）的患儿32例作为对照组。分析两组患者的临床特点、实验室检查、治疗及预后，采用Logistic回归分析法分析KDSS的独立危险因素。结果与对照组相比，KDSS组患儿年龄＞3岁（75.0％vs.21.9％，χ2=8.23，P<0.05），淋巴结肿大发生率（87.5％vs.40.6％，χ2=5.48，P<0.05）较高，中性粒细胞比例[（0.90±0.04）％vs.（0.66±0.15）％，t=8.42，P<0.05]，C反应蛋白[（221±116）mg/L vs.（73±54）mg/L，t=3.52，P<0.05]，N末端脑利钠肽前体（NT-proBNP）水平[（6192±2990）×10-6 mg/L vs.（739±691）×10-6 mg/L， t=5.12，P<0.05]较高，白蛋白[（22±4）g/L vs.（31±4）g/L，t=5.69，P<0.05]及血钠水平[（126.0±7.7）mmol/L vs.（135.6±2.2）mmol/L，t=3.49，P<0.05]较低，且易发生丙球无反应（62.5％vs.6.3％，χ2=14.49，P<0.05）及冠脉损害（87.5％vs.28.1％，χ2=9.17，P<0.05）。Logistic回归分析显示，患儿年龄＞3岁[OR=10.7，95％CI（1.8，65.2）]，中性粒细胞比例＞0.75[OR=17.9，95％CI （1.9，166.8）]，白蛋白<30 g/L[OR=11.7，95％CI（1.3，106.8）]及NT-proBNP升高[OR=29.0，95％CI（4.0，212.9）]是KDSS的独立危险因素（P均<0.05）。结论 KDSS患儿年龄较大，全身炎症反应明显，有低蛋白血症，NT-proBNP升高，且易导致丙球无反应及冠状动脉损害。
목적：분석천기병휴극종합정（KDSS）적림상특점급위험인소，이개선기예후。방법본연구납입2009년1월지2013년12월재온주의과대학부속육영인동의원진단위KDSS적환인8례（KDSS조），수집동일시기학진위천기병（혈류동역학은정）적환인32례작위대조조。분석량조환자적림상특점、실험실검사、치료급예후，채용Logistic회귀분석법분석KDSS적독립위험인소。결과여대조조상비，KDSS조환인년령＞3세（75.0％vs.21.9％，χ2=8.23，P<0.05），림파결종대발생솔（87.5％vs.40.6％，χ2=5.48，P<0.05）교고，중성립세포비례[（0.90±0.04）％vs.（0.66±0.15）％，t=8.42，P<0.05]，C반응단백[（221±116）mg/L vs.（73±54）mg/L，t=3.52，P<0.05]，N말단뇌리납태전체（NT-proBNP）수평[（6192±2990）×10-6 mg/L vs.（739±691）×10-6 mg/L， t=5.12，P<0.05]교고，백단백[（22±4）g/L vs.（31±4）g/L，t=5.69，P<0.05]급혈납수평[（126.0±7.7）mmol/L vs.（135.6±2.2）mmol/L，t=3.49，P<0.05]교저，차역발생병구무반응（62.5％vs.6.3％，χ2=14.49，P<0.05）급관맥손해（87.5％vs.28.1％，χ2=9.17，P<0.05）。Logistic회귀분석현시，환인년령＞3세[OR=10.7，95％CI（1.8，65.2）]，중성립세포비례＞0.75[OR=17.9，95％CI （1.9，166.8）]，백단백<30 g/L[OR=11.7，95％CI（1.3，106.8）]급NT-proBNP승고[OR=29.0，95％CI（4.0，212.9）]시KDSS적독립위험인소（P균<0.05）。결론 KDSS환인년령교대，전신염증반응명현，유저단백혈증，NT-proBNP승고，차역도치병구무반응급관상동맥손해。
Objective To investigate the clinical characteristics and risk factors of Kawasaki disease shock syndrome (KDSS), therefore to improve its prognosis. Methods Eight patients with KDSS (KDSS group) and 32 Kawasaki disease patients (hemodynamically stable) (control group) from the Second Affiliated Hospital of Wenzhou Medical University between January 2009 and December 2013 were enrolled in the study. The clinical features, laboratory examination, treatment and prognosis of all the patients were observed and compared between the two groups, and the independent risk factors of KDSS were analyzed by Logistic regression. Results The age of onset of the patients in the KDSS group were older than that in the control group. Compared with the control group, the age of onset>3 years(75.0%vs. 21.9%, χ2=8.23,P<0.05), the incidence rate of lymphadenectasis (87.5%vs.40.6%, χ2=5.48,P<0.05), the levels of percentage of neutrophils[(0.90 ± 0.04)%vs. (0.66 ± 0.15)%, t=8.42, P<0.05], C reactive protein [(221 ± 116) mg/L vs. (73 ± 54) mg/L, t=3.52, P<0.05] and N-terminal probrain natriuretic peptide (NT-proBNP) levels [(6 192 ± 2 990) × 10-6 mg/L vs. (739 ± 691) × 10-6 mg/L, t=5.12, P<0.05] of patients in the KDSS group were higher, while the serum albumin [(22 ± 4) g/L vs. (31 ± 4) g / L, t = 5.69, P < 0.05] and sodium levels [(126.0 ± 7.7) mmol / L vs. (135.6 ± 2.2) mmol / L, t=3.49, P<0.05] were significantly lower. The rate of heart damage was statistically higher in the KDSS group than in the control group, so that gammaglobulin unresponsive (62.5%vs. 6.3%,χ2=14.49, P<0.05) and coronary dilatation (87.5%vs. 28.1%, χ2=9.17, P<0.05) were occurred easily. Logistic regression showed that the independent risk factors of KDSS were age of onset>3 years [OR=10.7, 95%CI (1.8, 65.2), P<0.05], percentage of neutrophils>0.75 [OR=17.9, 95%CI (1.9, 166.8), P <0.05], albumine<30 g/L [OR=11.7, 95%CI (1.3, 106.8), P<0.05] and higher level of NT-proBNP[OR=29.0,95%CI(4.0, 212.9), P<0.05]. Conclusion KDSS patients had older age of onset, obvious systemic inflammatory reaction, hypoproteinemia and higher level of NT-BNP, resulting in gammaglobulin unresponsive and coronary artery lesions.