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Long-term follow-up of coronary artery lesions in children in Kawasaki syndrome

长期随访冠状动脉病变在川崎综合征

  • 影响因子:2.24
  • DOI:10.1007/s00431-020-03712-6
  • 作者列表:"Maccora, Ilaria","Calabri, Giovanni Battista","Favilli, Silvia","Brambilla, Alice","Trapani, Sandra","Marrani, Edoardo","Simonini, Gabriele
  • 发表时间:2020-06-15
Abstract

To describe clinical and epidemiological characteristics of a Kawasaki syndrome cohort. In a monocentric, retrospective, observational study, between February 1982 and August 2018, we enrolled 361 children, aged 1 month to 24.4 years. Coronary artery lesions were detected in 20.2% of patients: 16% had coronary ectasia, and 4.15% had coronary aneurisms. A significant difference regarding age at disease onset ( p  = 0.025), fever duration ( p  < 0.0001), CRP ( p  = 0.001) and day of first IVIG administration ( p  < 0.0001) was detected among group. A significant correlation between coronary artery lesions and disease onset < 6 months ( p  = 0.009), second IVIG dose ( p  < 0.001) and male gender ( p  = 0.038) has been detected. Median long-term follow-up was 10.2 years (1–36 years). At the last available follow-up, patients without coronary involvement and coronary ectasia had normal cardiological tests, conversely, in patients with aneurisms, 8/13 showed persistent aneurisms at echocardiography, one ECG repolarization alterations, and one ST depression at the peak of effort during ergometric test. Conclusion : Children with lower age, longer fever, higher level of CRP and retard in IVIG administration are at higher risk to develop coronary artery lesions. Our long-term follow-up analysis confirms, over 36 years of observation, the benign course of Kawasaki syndrome even in coronary artery lesion patients, if timely treated. What is already known about this topic? • Stopping cardiologic assessment in no risk patients results economically advantageous, timesaving and able to reduce emotional discomfort in children and their families. • Age at disease onset, fever duration, CRP level, and day of first IVIG administration are possible risk factors for coronary artery lesions What is New? • During 36 years of observation in real life, our study shows the benign course of Kawasaki syndrome without coronary artery lesions after 6–8 weeks from the disease onset. • Age < 6 months at disease onset is strongly related with coronary artery lesion development.

摘要

描述川崎综合征队列的临床和流行病学特征。在 1982 年 2 月至 2018 年 8 月的一项单中心、回顾性、观察性研究中,我们招募了 361 名 1 个月至 24.4 岁的儿童。20.2% 的患者检出冠状动脉病变: 16% 有冠状动脉扩张,4.15% 有冠状动脉瘤。发病年龄 (p = 0.025) 、发热持续时间 (p <0.0001) 、 CRP ( p = 0.001) 差异有统计学意义检测各组间 IVIG 首次给药日 (p <0.0001)。冠状动脉病变与发病 <6 个月 (p = 0.009) 、第二次 IVIG 剂量 (p <0.001) 显著相关男性 (p = 0.038) 已检出。中位长期随访时间为 10.2 年 (1-36 年)。在最后一次随访中,无冠状动脉受累和冠状动脉扩张的患者心脏检查正常,相反,在动脉瘤患者中,8/13 的患者在超声心动图上显示持续动脉瘤,一次心电图复极改变,在测力计测试过程中,在努力的高峰期出现一次抑郁。结论: 年龄较小、发热时间较长、 CRP 水平较高、 IVIG 使用时间较长的患儿发生冠状动脉病变的风险较高。我们的长期随访分析证实,超过 36 年的观察,即使在冠状动脉病变患者川崎综合征的良性过程,如果及时治疗。关于这个话题已经知道了什么?•在无风险患者中停止心脏评估,结果经济上有利,省时,能够减少儿童及其家庭的情绪不适。•发病年龄、发热持续时间、 CRP 水平和首次 IVIG 给药日期是冠状动脉病变的可能危险因素。什么是新的?•在现实生活中 36 年的观察中,我们的研究显示了从发病 6-8 周后无冠状动脉病变的川崎综合征的良性病程。•发病年龄 <6 个月与冠状动脉病变发展密切相关。

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