【作者】 徐海燕；

【导师】 龚方戚；

【作者基本信息】 浙江大学 ， 儿科学， 2015， 硕士

【摘要】 背景及目的：川崎病(Kawasaki disease, KD)是一种病因不明,发生在婴幼儿的急性全身性血管炎,主要影响中小型动脉,特别是冠状动脉,而冠状动脉病变(coronary artery lesions, CALs)严重影响病人的预后。有研究表明红细胞分布宽度(red blood cell distribution width, RDW)是心血管疾病及其他多种疾病病死率及不良预后的强有力的预测因子,且校正了其他影响因素后,该相关性仍然存在。本研究旨在通过回顾性分析探讨RDW对川崎病冠状动脉病变的预测价值。资料与方法：对422例2009年8月至2012年10月因川崎病收治于浙江大学医学院附属儿童医院的病例进行回顾性分析,根据随访心脏超声结果将患者分为冠状动脉病变组(CALs)及非冠状动脉病变组(NCALS)两组,比较两组患者间RDW是否存在差异。再通过ROC曲线计算出预测冠状动脉病变的RDW切割值,并按此切割值将病例进一步分为高RDW组和低RDW组,比较两组之间临床、心脏超声心动图检查结果、血液学参数及生化等指标是否有统计学差异。最后利用多因素回归分析,筛查川崎病患者发生冠状动脉病变的危险因素。所有数据采用SPSS 16.0统计学软件包进行统计分析,P<0.05为两组间有统计学差异。结果：422名川崎病患者中,CALs组83人(19.7%),NCALs组339人,CALs组的RDW值明显高于NCALs组,差异具有统计学意义(P<0.01)。根据ROC曲线分析,RDW预测CALs的最佳切割值为14.55%(曲线下面积为0.721；P=0.000),其中CALs组中有70%的患者RDW水平>14.55%。多因素回归分析显示,发热持续时间>14天(OR 3.42,95% CI 1.27-9.22; P=0.015),丙种球蛋白耐药(OR 2.33, 95% CL 1.02-1.02; P=0.04)和RDW>14.55%(OR 3.49,95% CL 2.01-2.01; P=0.000)是川崎病患者发生CALs的独立危险因素。结论：1.RDW对川崎病患者的冠状动脉病变有预测价值,高水平RDW值的患者CALs发生率高。2.发热时间>14天、丙种球蛋白耐药及RDW>14.55%均为川崎病患者发生CALs的独立危险因素。更多还原

【Abstract】 Background and purpose:Kawasaki disease (KD) is an acute multisystemic vasculitis of unknown etiology that occurs in infants and children, it primarily affects small and medium-sized arteries, especially coronary artery. And coronary arterial lesions (CALs) seriously affects patients’ prognosis. Recent studies have reported that higher red blood cell distribution width(RDW) is an independent predictor of mortality and poor prognosis in patients with cardiovascular and other diseases, even after adjustment for other factors. The purpose of our study is to assess the predictive value of red cell distribution width (RDW) for coronary artery lesions (CALs) in patient with Kawasaki Disease (KD).Materials and Methods:Between August 2009 and December 2012,422 patients with KD were enrolled in this study at the Children’s Hospital, Zhejiang University School of Medicine. Patients were divided into 2 groups:CALs group and NCALs group according to their Echocardiographic examination, to find if there was significant difference with RDW between the two groups. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting CALs was 14.55%. Then the patients were divided into two groups:higher RDW group (RDW>14.55%) and lower RDW group (RDW<14.55%), clinical, echocardiographic and biological variables were evaluated in the two groups, to determine the variables independently associated with RDW levels. At last, we use Logistic regression analysis to find the independent predictors of CALs in patient with KD. All statistical analyses were performed using SPSS software version 16.0. A P value of 0.05 was considered statistically significant.Results:Four hundred and twenty-two consecutive patients with KD were enrolled. And eighty-three patients (19.7%) have CALs, while three hundred and thirty-three without CALs. There was significant difference in RDW(P<0.01), the level of RDW was much more higher in CALs group than NCALs group. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting CALs was 14.55%(area under the curve was 0.721; P=0.000).70% of patients with CALs had RDW level>14.55%.Logistic regression analysis revealed that fever duration> 14 days (odds radio [OR] was 3.42,95% confidence interval [CI] was 1.27-9.22; P=0.015), IVIG resistance (OR was 2.33,95% CI was 1.02-5.29; P=0.04) and RDW>14.55% (OR was 3.49,95% CI was 2.01-6.05;P=0.000) were independent predictors of CALs in patients with KD.Conclusion:1. RDW was a valuable factor for predicting CALs in patients with Kawasaki disease, and the morbidity of CALs is high in patients with high levels of RDW values.2. Fever duration> 14 days、IVIG resistance and RDW>14.55%were independent predictors of CALs in patients with KD.更多还原