Study On Epidemiology Of Kawasaki Disease In Jilin From 1999 Through 2008

Objectiv:To investigate the epidemiologic feature of Kawasaki disease (KD) in Jilin Province from 1999 through 2008 and analyze the possible risk factors of acute coronary lesion (CAL) of KD ,which will be helpful to prevent, therapy earlier ,evaluation of prognosis.Methods:The survey forms unified of standard KD epidemiology were used and sent to the province's 32 hospitals above the county and city level with pediatric in-patients, in order to conduct a survey on the KD children during 10-years period from January 1, 1999 to December 31, 2008.The questionnaire form include sage, sex, inhabit, nationality, the date of birth and onset, clinical symtoms, the results of Echocardiogram (Echo), laboratory tests, treatment, outcome, cardiac sequelae, recurrence, etc. The forms being recived and then collected ,finished, analyzed, two vice-professors inspected and got rid of those cases that were not qualified patients with KD. All the statisties analysis were conducted by SPSS15.0. Univariate analysis was Performed by ANOVA, chi-square test. An odds ratio and 95% confidence interval were estimated by means of a multivariate logistic model.And P<0.05 represents the statistie signifieance. Results:93.75% of the survey forms came back. 577 KD cases were reported from the 32 hospitals of 9 districts. Most cases were reported in large hospital and there were not cases in sixteen country hospital,which were small and far from the city center. The incidence of KD was of an increasing trend. 18 cases in 1999, while it was up to 122 cases in 2008. Male were 382(66.2%), female were 195(33.8%). The ratio of male and female was 1.96 to 1. The age of patients varied from 58 days to 14 years, those under 5 years of age accounted for 88.73%. The disease occurred all over the year, and was expressed by adouble-Peak curve,and The disease occurred more frequently from May to July and November. The disease occurred the fewest in February. Most patients had diarrhea and infection symptoms in respiratory tract. There are four minorities in patients (50cases, 8.7%) and dispersed in distribution. It was not evidence to show that The incidence was increased in a certain minority. Time between visiting and onset was 7.58±4.63d. Diagnostic patients were less in six days. 553 patients accepted an Echo examination and cardiac abnormalities were found in 63.26% of Patients.The most common abnormality was coronary artery lesions in cluding dilatation (49.5%) and stenosis (13.4%). Compared incomplete to complete Kawasaki disease, the result showed significant differences in occurrence of CAL and frequenty was higher in incomplete Kawasaki disease,while no significant differences in sex. 14 (2.4%) of them remained the cardiac sequelae and the male/female ratio was 3.67: 1. The younger the age,the higher the incidence of cardiac sequelae.The mainest cardiac sequelae was coronary artery ectasia.The recurrence rate was 0.5% and recurrent patients were boys.There were twin boys onset interval one month in all patients. There was no death during acute period.Clinical symptoms: Fever (99.5%) was the most common clinical symptom,followed by rash (75.9%), conjunetiv congestion (76.1%), oral changes (90.6%), extremities desquamate (84.8%), lympha denopathy (69.3%). In addition crissum desquamate (32.9%) and erythema (1.7%) in the spot of BCG inoculation. Respiratory system was the most common damaged symptem in other systems, followed by digestive system. damaged can be see in blood, urinary, joints of extremities.Laboratory tests and auxiliary examination: The data of ESR, CRP, BPC, albumin proteinare, liver function, myocardial enzyme, urine routine and the result of ECG, Holter, Echo, etc.Correct rate of diagnosis: 480 (83.2%) of all patients accorded with diagnostic guidelines for KD and 97 (16.8%) were IKD. Suspected cases were encluded in the study.Treatment: A total of 577 cases had been given ASA. 512 of them had been given IVIG and the common dose were 400mg.kg-1X5 (39.9%) and 1g.kg-1X2(25.7%). One of them was not effective to IVIG. There was no adverse IVIG effect reported. 92 of all had been given corticosteroids before they were diagnosised.One case had been given corticosteroids because of no effection to IVIG. There were 80 patients combined with corticosteroids, who did not occur CAL before, 64 of them occurred CAL, two accompanied mural thrombus which did not dispear after one month and two occurred coronary aneurysms.Conclusion:The incidence of KD in Jilin is in an increasing trend. The age and gender distribution are not exactly the same to previous reports. Seasonal distribution is different to previous other reports of domestic, United State, Japan and Taiwan. Age and serum albumin (<30g/L) are the risk factors of CAL in KD. The younger the age, the higher the incidence of CAL and the higher the incidence of cardiac sequelae. It is posible that the patients treated with corticosteroids are more easily to occur CAL.