The Clinical Significance Of The Kawasaki Disease Clinic Analysis In A Single Centre & Common Laboratory Index During The Early Diagnosis Of Kawasaki Disease

Part Ⅰ The clinical significance of the Kawasaki disease clinic analysis in a single centreResearch Objectives This thesis provides reference for the clinical diagnosis and treatment of Kawasaki Disease(KD) by clinical retrospective reviewing 171 cases of children with KD. Researchs focued on the clinical characteristics of different age, complete and incomplete KD, and the severity coronary artery lesion.Methods Retrospective reviewing the clinical data of the 171 KD cases in the institute from Dec 2011 to Dec 2015 was performed. The cases were divided into(1)KD ≤1goup, KD 1~3 group and KD ﹥ 3 group;(2)complete KD(c KD) group and incomplete KD(i KD) group;(3)coronary artery lesion(CAL) group and noncoronary artery lesion(NCAL) group. Demographic and clinical date includeed age,gender, clinical manifestation and laboratory index(blood C-reaetive protein,erythrocyte sedimentation rate, procalcitonin, white blood cell count, emoglobin,blood platelet count, alanine aminotransferase, glutamic oxalacetic transaminase,albumin, blood sodium, Creatine kinase isoenzyme, d-dimer, CD3+, CD3+ CD4+,CD3+ CD8+, CD3+ CD4+/ CD3+ CD8+) and echocardiography. Statistical analysis of general date, clinical manifestation, auxiliary examination was made between different groups to study the diffenrence of the laboratory index above. Logistic multi-factor regression analysis of the meaningful variables, which would influence the CAL was made at the same time to ascertain the independent risk factor.Results1. Compared with 1~3 KD group and >3 KD group, the incidence of erythema around the BCG scar KD≤1 group(P ﹤ 0.0125) increase, lymphadenectasis decrease(P﹤0.0125), conjunctival injection is lower than KD 1~3 group(P﹤0.0125), Oral hyperemia cracked lower than KD>3 group(P﹤0.0125). And there was no difference in the clinical manifestation between KD 1~3 geoup and KD>3group.Compared with KD1~3 group and KD>3 group, there were sinificant difference of the Hb reduction, PLT rise, CD3+CD4+ rise, CD3+CD8+ reduction and CD3+CD4+/ CD3+CD8+ rise for KD≤1 group(P﹤0.05). Compared with KD>3group, there was no difference in other indexes except the rise of CD3+CD4+(P﹥0.05).2. There was age difference between i KD group and c KD group(P﹤0.05).And obviously, It’s proved that i KD≤1 years old was higher than c KD. There was no difference of the gender in these two groups(P ﹤ 0.05). All the clinical manifestation of i KD group and c KD group, excep desquamation around anus and erythema at the sites of BCG(P﹤0.05). The Hb level of i KD group is lower than c KD group(P﹤0.05), but PLT, CD3+CD4+、CD3+CD4+/CD3+CD8+ level is higher(P﹤0.05), and no difference in other indexes(P﹤0.05). The incidence of CAL complication for i KD group ≤1 cases is higher than c KD(P﹤0.05).3. There was great difference in the age composition in CAL group and NCAL group(P﹤0.05). It’s proved that CAL≤1 years old was higher than NCAL. There was no difference in the gender composition of two groups(P ﹤ 0.05). In CAL group, the incidence of erythema at the sites of BCG was 28.21%, which is obviously higher than 14.39% of the NCAL group(P﹤0.05), and there was no difference in other clinical manifestation(P ﹤ 0.05). Significance variables in single factors, Age, ALB, HB, plasma sodium, D-D were counted in multivariate logistic regression. The result showed that ALB< 35g/l, increase of D-D, ≤1 year old is the independent risk factor of KD combine with CAL.Conclusion There is different clinical manifestations, laboratory examinations and CAL complication for different age. Paying attention to the difference will help to the early diagnosis of Kawasaki Disease.1. There is difference in clinical manifestation for different ages. The symptom of ≤1 KD group is not typical, but higher incidence of erythema at the sites of BCG,and lower Hb and CD3+CD8+,and higher PL、CD3+CD4+和 CD3+CD4+/CD3+CD8+.The clinical manifestations are similar in grou 1~3 KD group and >3KD group.2. There is age difference for i KD and c KD. The high i KD incidence and CAL complication is high in ≤1KD group. The incidence of cardinal symptom of i KD is obviously lower than c KD but the desquamation around anus and erythema at the sites of BCG is higher. The change of laboratory indexes for i KD and c KD are not all the same, howvere, the level of Hb is lower than c KD, PLT, CD3+CD4+,CD3+CD4+/CD3+CD8+ higher than c KD.3. There is age difference in KD complication CAL. CAL and erythema at the sites of BCG incidence is higher in ≤1KD group. Amount the risk factors, age,ALB, Hb, plasma sodium, D-D, ALB ﹤ 35g/L, D-D rise, and age ≤1 are CAL independent risk factor.Part Ⅱ Common laboratory index during the early diagnosis of Kawasaki diseaseResearch Objectives This thesis explores the significance of laboratory index in early distinguishing and diagnosis between Kawasaki disease and bacterial infection fever and provides important reference for the diagnosis and cure of KD by comparing the laboratory index of KD and bacterial infection fever.Methods Retrospective analyzed the 171 cases of children with KD in our hospital from Dec 2011 to Dec 2015, at the same time, chose 175 cases of same age and gender composition children with bacterial infection fever(fever>5 days and body fluid cultivation) as control group. The levels of C-reactive protein(CRP), blood routine indexes(WBC, HB, PLT), liver function(ALT, AST and ALB), electrolyte(plasma sodium), myocardial enzyme(CK-MB), T cell subset(CD3+, CD3+CD4+,CD3+CD8+, CD3+CD4+/ CD3+CD8+) and procalcitonin(PCT) for two groups were compared and studied to screen out meaningful variable for the further study of the ROC curve.Result1. The measured value of CD3+, CD3+CD4+, CD3+CD4+/ CD3+CD8+ for KD group were(65.38±8.84)%,(38.95±8.64)%,(2.03±0.89)%. The levels are higher than bacterial infection fever group which were(53.11±9.52)%,(28.12±9.20)%,(1.72±0.98)%. The difference of the indexes for two groups has the statistical significance(P﹤0.05). The measured value of PCT was 0.91±2.26ng/ml, which was lower than bacterial infection fever group 17.38±25.63ng/ml, therefore the difference of the indexes for two groups has the statistical significance(P﹤0.05).The measure values of CRP, WBC, PLT, Hb, ALB, ALT, AST, plasma sodium,CK-MB, CD3+CD8+ had no difference between both groups, so that there is no statistic difference(P﹤0.05).2. The area under CD3+, CD3+CD4+, CD3+CD4+/ CD3+CD8+ KD diagnosis ROC curve were 0.837, 0.806, 0.593, the diagnostic poin 61.05%, 32.45%, 0.99%,the sensitivity of KD diagnose 71.9%,78.9%,91.8%, specificity 82.9%, 69.1%,32.0%. So CD3+, CD3+CD4+ have better diagnostic efficiency than CD3+CD4+/CD3+CD8+.3. The area under ROC curve for PCT is 0.891, with 0.729ng/ml as diagnostic point. The sensitivity of KD was 76%, specificity 90.9%. So PCT has good KD diagnostic efficiency.4. Examine for the area of the three high diagnostic efficiency indexes showed the comparison between PCT and CD3+ was Z=2.00(P ﹤ 0.05), PCT and CD3+CD4+ Z=2.97(P﹤0.01). So PCT has better diagnostic efficiency than CD3+and CD3+CD4+.Conclusion1. The measure value of CRP, WBC, PLT, Hb, ALB, ALT, AST, plasma sodium, CK-MB, CD3+CD8+ for both groups don’t have obvious difference. The dependability for ealy KD diagnose is low.2. The serum PCT, CD3+, CD3+CD4+, CD3+CD4+/ CD3+CD8+ can be used as the laboratory index for early ealy KD diagnose. However, PCT has higher positive and negative predictive value, so the dependability of CD3+CD4+/ CD3+CD8+ for ealy KD diagnose is low.