Epidemiologic Research Of Kawasaki Disease In Shanghai From 2003 Through 2007

Objective:To investigate the epidemiologic feature of Kawasaki disease(KD) in Shanghai from 2003 through 2007 and analyse the possible risk factors of acute coronary lesion and cardiac sequelae and the recurrence of KD in order to optimize the therapeutic proposal on Kawasaki disease furtherly.Methods:The subjects of this study were selected from central or tertiary hospitals,which provide children's medical care in Shanghai.All patients in this survey were identified by the discharge diagnosis code in medical records with Kawasaki disease during January 2003 through December 2007.According to the survey of KD national research in Japan,a questionnaire form and diagnostic guideline for Kawasaki disease was established and sent to the hospitals.The questionnaire form includes age,sex, inhabit,nationality,the date of birth and onset,clinical symptoms,the results of ECHO and ECG exams,laboratory tests(ESR,CRP,BPC and albumin protein),dose and period of initial treatment of IVIG and steroids,prognosis,etc.The information of qualified patients has been collected and put into a databank. All the statistics analysis were conducted by SPSS13.0.Univariate analysis was performed by ANOVA,t-test,chi-square test and Fisher's test.An odds ratio and 95% confidence interval were estimated by means of a multivariate logistic model.And P＜0.05 represents the statistic significance,while P＜0.01 shows a noticeable one.and the completed survey forms were retumed to us.Results:1) Return rate of questionnaire:50 hospitals took part in the survey.The return rate was 100%.A total of 1187 qualified patients with Kawasaki disease were reported.2) Incidence rate:The incidence rate of Kawasaki disease were 36.78-53.28 per 100,000 children under 5 years of age in Shanghai,which shows an increase trend in incidence.But for each year they were 43.06(2003),53.28(2004),50.35(2005), 48.12(2006),and 36.78(2007) per 100,000 children under 5 years of age,and no increase by year were found. 3) Age at onset:The age of onset ranged from 12 days to 13.6 years(median 1.75 years).The age-specific incidence rate was expressed by a double-peak curve, and the peaks were at 10 months and 1 year.The overall age distribution shows that 84.8%of patients are under 5 years of age,and 30%of patients are under 1 year of age.4) Gender:The male/female ratio was 1.698∶1.5) Region distribution:The birth place of the patients showed a majority of Shanghai(806,67.9%),followed by Zhejiang(116,9.8%) and Jiangsu(95,8%) Province.843 cases are permanent residence of Shanghai.6) Seasonal distribution:The disease occurred more frequently from May to August and there is a double-peak in incidence in female.7) Clinical symptoms:Fever(98.5%) was the most common clinical symptom, followed by oral changes(86.4%),extremities desquamate(82.7%),conjunctive congestion(81.5%),rash(75.8%),lymphadenopathy(63.4%),and crissum desquamate(42.5%).8) Echocardiogram:A total of 1172 patients accepted an Echo,and cardiac abnormalities were found in 24.2%of patients.The most common cardiac abnormality was coronary artery lesions including dilatation(64.1%) and aneurysm (17.6%).9) Electrocardiogram:A total of 947 patients accepted an ECG,and an abnormal rate of 32.8%was showed.The most common abnormality is the change of T wave (58.2%).10) Laboratory tests:The data of ESR,CRP,BPC and albumin protein are obtained in this study.The average:ESR:69.0±31.18 mm/h,PLT:489.43±164.28×10⁹/L,CRP:84±55mg/L,albumin protein:35.45±5.28g/L。11) Strategy of IVIG:A total of 1020 cases had been given IVIG and the common dose were 1g/kg×2(432) and 2g/kg×1(421).A total of 741 cases got the IVIG during the 5^th and 9^th of illness day,while 80 cases within 5^th day and 199 cases after 9^th day.The univariate analysis suggested a statistic significance of IVIG dose (P=0.029) and period(P=0.000).There was noadverse IVIG effect reported.12) Corticosteroids:Corticosteroids were used differently among the hospitals.13) Fatality and recurrence rate:The fatality rate at acute stage of the disease was 0%in this study.A second onset of the disease occurred in 1.2%of patients.14) Coronary artery lesion:Coronary artery lesions were found in 232 patients at acute stage and 129 of them remained the cardiac sequelae after 1 month.6 cases without CAL at acute stage were found CAL during the following-up15) Risk factors:Highly increase of BPC and ESR,the recurrence cases,＜1 month of age and＞10days of duration of fever may be the risk factors of the CAL, and the later four factors and male gender may also be related to cardiac sequelae. Cardiac sequelae may be the risk factor of recurrence.Conclusions:1.The study shows increasing trend of incidence rate of Kawasaki disease in latest 5 years in Shanghai,but the incidence is lower than that reported in Japan and higher than those in western countries.2.Sex and age distributions,clinical symtoms and recurrence rate are similar to those in previous reports of other countries and areas.The seasonal distribution is similar to the report from Beijing and the previous one but different from other reports.3.The rate of cardiac lesion diagnosed by ECHO was similar to other reports.4.Logistic analysis showed highly increase of BPC and ESR,the recurrence cases,＜1 month of age and＞10days of duration of fever may be the risk factors of the CAL,and the later four factors and male gender may also be related to cardiac sequelae.Cardiac sequelae may be the risk factor of recurrence.