Analysis Of Clinical Characteristics Of Kawasaki Disease And Clinical Significance Of Z Score In The Evaluation Of Coronary Artery Lesions

Background: Kawasaki disease is a self-limited and systemic vasculitis with a specific predilection for small-and medium-sized arteries,especially coronary arteries,which is an essential factor affecting the long-term prognosis of Kawasaki disease.Once severe coronary artery lesions and coronary aneurysms are developed,there is no effective treatment except drugs to prevent thrombosis,and the prognosis is poor.Z-score adjusted by Body surface area have gradually replaced the traditional absolute values of coronary internal diameter as a new criterion for determining the severity of coronary artery lesions in KD recently,and have achieved encouraging clinical results.However,the Z-score calculation system and the criteria for coronary artery lesions are still controversial internationally.The relevant Z-score calculation system has not been established in China,and the application of Z-score has not formed a consensus.Therefore,the selection of an appropriate method for coronary lesion evaluation is still an urgent issue in KD diagnosis,treatment,and follow-up.Objective: To investigate the epidemiological and clinical features of Kawasaki disease(KD)in Taihe Hospital Affiliated to Hubei University of Medicine and to explore the clinical value of Z-score based on the Dallaire system to quantitatively assess the severity,prognosis,and risk prediction of coronary artery lesions in children with Kawasaki disease.Methods:1 The clinical data of 334 children with KD hospitalized at the Children’s Treatment Center of Taihe Hospital in Shiyan from January 2014 to December 2019 were retrospectively analyzed,including epidemiological characteristics,clinical manifestations,and laboratory tests.2 The degree of coronary lesions in KD was classified according to the Z-score criteria based on the Dallaire system and the conventional coronary internal diameter criteria,respectively,to compare the differences in the incidence and site of involvement of CAL between the two evaluation criteria in the acute phase.The regression rate of different degrees of CAL at 3,6,12,and 24 months after discharge and the incidence of CAL between different IVIG treatment regimens were analyzed under the Z-score criteria.3 Patients with KD were divided into CAL group(n=121)and NCAL group(n=213),CAA group(n=92)and NCAA group(n=242),small CAA group(n=59)and large CAA group(n=33)according to the Z-score of coronary artery in echocardiography in the acute phase.The univariate analysis was performed for the factors that might influence CAL formation before the initial administration of IVIG,then Logistic regression analysis was used to determine independent risk factors.Results:1 From 2014 to 2019,the number of children with KD in our hospital has been increasing gradually.The incidence was high in spring and summer,with a peak incidence from April to August.88% were under 5 years old,and the peak incidence was from 1 to 3 years old.Male:female = 1.57:1.All children presented fever.Other clinical manifestations mainly included oral changes(78.7%)and conjunctivitis(78.4%).Mitral regurgitation,tricuspid regurgitation,sinus tachycardia,and respiratory tract infection symptoms were the most common cardiac and extracardiac non-specific manifestations.WBC,N%,PLT,HB,NLR,CRP,ESR appeared to be increased to varying degrees during the acute phase of KD,and after IVIG treatment WBC,N%,HB,NLR,CRP were lower,and ESR,PLT continued to rise(P<0.05).WBC,N%,NLR,PLR,CRP,ESR,ALT,and TB were lower and CK-MB was higher in children with incomplete KD compared with typical Kawasaki disease(P<0.05).2 Based on the absolute value of coronary internal diameter and Z-score,139(41.6%)and 121(36.2%)cases of CAL and 28(20.1%)and 92(76.0%)cases of CAA were detected,respectively,and the difference in the incidence of CAL between the two groups was not statistically significant(P>0.05),but the incidence of CAA was higher for Z-score criteria than for coronary internal diameter criteria,and the difference was statistically significant(P<0.05).The left main stem was the most frequently involved site of CAL by both criteria.The recovery rates at 3 months,6 months,12 months,24 months with Z-score criteria were: CAD group: 77.8%,81.5%,100%,and 100%;small CAA group: 64.6%,77.3%,81.4%,and 92.7%;medium CAA group: 66.7%,71.4%,75.0%,and 84.0%;and huge CAA group: 0%,20%,and 40%,40%.3 Logistic regression analysis results showed that male,incomplete KD,and disease duration >10 days at IVIG administration are the independent risk factors for CAL(β>0,P<0.05,OR>1);male,disease duration >10 days at IVIG administration are the independent risk factors for CAA(β>0,P<0.05,OR>1);disease duration >10 days at IVIG administration(β>0,P<0.05,OR>1),hypoalbuminema(β<0,P<0.05,OR<1)are the independent risk factors for large CAA.Conclusion:1 In this study,KD always occurs in boys aged less than five years old in spring and summer,and the number of KD is increasing gradually.The inflammatory indexes increase in the acute phase of KD and mostly decrease after treatment,while ESR and PLT continue to increase;incomplete KD inflammatory indexes are lower than typical KD.2 Z-score based on the Dallaire system was more sensitive to the occurrence of severe coronary lesions,especially CAA and giant CAA.3 Based on the Z-score evaluation of the Dallaire system,male,incomplete KD,and disease duration >10 days at IVIG administration were risk factors for KD complicating CAL;male,disease duration >10 days at IVIG administration were risk factors for KD complicating CAA;disease duration >10 days at IVIG administration and hypoalbuminemia were risk factors for KD complicating large CAA.