Clinical Characteristics And Early Warning Indicators Of Incomplete Kawasaki Disease In Central And Western Inner Mongolia

Objective:Improve the early recognition level of incomplete Kawasaki Disease(iKD)in the central and western regions of Inner Mongolia,and explore the early warning indicators of coronary artery lesions(CAL)complicated by iKD.Method:Retrospective analysis of 249 cases from the Department of Pediatrics of Inner Mongolia Autonomous Region Maternal and Child Health Hospital from January 1,2018 to December 31,2021 from Kawasaki Disease(KD)in the central and western regions of Inner Mongolia,divided into complete Kawasaki disease(cKD)group(164cases)and iKD group(85 cases)according to clinical manifestations,comparing the age,sex,clinical manifestations of the two groups,Laboratory test results(white blood cell count(WBC),hemoglobin(Hb),neutrophil ratio(NEUT%),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),N-terminal pro-brain natriuretic peptide(NT-proBNP),alanine transaminases(ALT),aspartate aminotransferase(AST),γ-Gltamyl transpeptidase(γ-GGT),albumin(Alb),total cholesterol(TC),triglycerides(TG),Differences in treatment effects of low-density lipoprotein(LDL),high-density lipoprotein(HDL),apolipoprotein A(APO-A),apolipoprotein B(APO-B)and treatment effects were divided into CAL(35 cases)and non-coronary artery damage groups(NCAL,50 cases)according to the results of cardiac ultrasound,and the clinical data were analyzed univariately,and the risk factors for the occurrence of CAL in iKD were analyzed using multifactorial logistic regression.Results:1)General data: the incidence of iKD in the <1-year-old group was higher than that in the cKD group,and the two groups had statistical significance in the age of onset(P<0.05);the two groups were not statistically significant in sex.2)Clinical manifestations: in cKD,159 cases(97.0%)of bilateral bulbous conjunctival congestion,141 cases(86.0%)of oral and lip mucosa changes,140 cases of rash(85.4%),132 cases(80.5%),103 cases(62.8%)of neck lymph node non-purulent swelling and 22 cases(13.4%)of perianal deconstruction were higher than the incidence of bilateral bulbous conjunctival congestion in iKD group 59 cases(69.4%),and 40 cases(47.1%)of oral and lip mucosal changes.The incidence of peripheral changes in limbs was 37(43.5%),non-purulent enlargement of cervical lymph nodes in 24 cases(28.2%),and perianal peeling(3.5%)in 40 cases(47.1%),and 3 cases(P<0.05)with peripheral disfoliation.The average fever days in the cKD group(5.21± 1.74 days),the iKD group(6.95±1.75)had a long fever duration(P<0.05),and the incidence of card scar redness in the iKD group was higher than that in the cKD group(34.1%),which was statistically significant(P<0.05)。3)Laboratory tests: the levels of NEUT%,CRP,NT-proBNP,γ-GGT in the cKD group were higher than those in the iKD group(P<0.05);the Hb level in the iKD group was lower than that in the cKD group(P<0.05);WBC,ESR,ALT,AST,Alb,TC,TG,LDL,HDL,APO-A,APO-B were not statistically significant in the two groups of children;4)Treatment and incidence of coronary artery damage: the incidence of no response to gamma globulin therapy in the iKD group was significantly higher than that in the cKD group(P<0.05).The incidence of coronary artery damage was higher in the iKD group than in the cKD group(P<0.05).5)In the iKD group,males in the CAL group were more common,the fever lasted for a long time,the CRP,NT-proBNP,TG,LDL levels were higher than those in the NCAL group,and the HDL level was lower than that in the NCAL group(P<0.05).6)Multivariate logistic regression analysis suggested that males(OR=1.78,95% CI: 1.25-2.53),CRP(OR=2.20,95% CI: 1.06-4.57),NT-proBNP(OR=2.36,95% CI: 1.11-5.03),TG(OR=2.95,95% CI: 1.19-7.28)and HDL decreased(OR=0.08,95% HDL)CI: 0.01-0.78)is an independent risk factor for iKD coronary damage.Conclusion:1.Compared with cKD,the children in the iKD group had a small age of onset,common under 1 year old,a long duration of fever,easy to appear scarred and red,easy to be anemia,no response to gamma globulin treatment and a high incidence of coronary artery damage.2.Males,CRP,NT-proBNP,elevated TG and decreased HDL are independent risk factors for iKD complicated coronary artery damage.