作者：Chun-Na Zhao 译者：姚中强 校者：孙琳

摘要: 背景:冠脉损害 (CALs)是川崎病(KD)患儿的主要并发症。除了静脉丙种球蛋白(IVIG)之外，糖皮质激素也用于治疗IVIG无效的患儿。本研究旨在评估川崎病患儿冠脉损害的危险因素。

方法:我们回顾性分析了2005年1月到2014年12月之间2331 名川崎病患儿的病历。用单因素logistic回归分析发现的显著危险因素进行多因素logistic回归分析，以发现冠脉损害的独立危险因素。

结果:冠脉损害的发生率为36.0% (840 /2331), 包括 625 (26.8%) 冠脉扩张和215 (9.2%) 冠脉血管瘤 (CAAs)。 多因素logistic 回归分析发现，男性、不完全川崎病、发热持续时间更长、C反应蛋白 (CRP) >100 mg/L 是冠脉扩张的独立危险因素。另外一方面，男性、不完全川崎病、发热持续时间更长、初始治疗后疾病持续时间长、糖皮质激素治疗、钠≤133 mmol/L、白蛋白 <35 g/l 是冠脉血管瘤的独立危险因素。而且，糖皮质激素治疗、初始治疗后疾病持续时间长、白蛋白 <35 g/l 是巨大冠脉血管瘤的独立危险因素。

结论:冠脉损害可能与男性、不完全川崎病、发热病程长、初始治疗后疾病持续时间长、白蛋白 <35 g/l、钠≤133 mmol/l、 crp>100 mg/L和糖皮质激素治疗相关。糖皮质激素治疗是冠脉血管瘤和巨大冠脉血管瘤的独立危险因素。因此，对于有冠脉损害风险的川崎病患者应慎用糖皮质激素。

附原文：Background:Coronary artery lesions (CALs) are known to be the main complication in children with Kawasaki disease (KD). Instead of intravenous immunoglobulin (IVIG), corticosteroid therapy has been accepted to be used for children with KD who are unresponsive to IVIG. This study aimed to evaluate risk factors for CALs in children with KD.Methods:We retrospectively reviewed the clinical records of 2331 children with KD from January 2005 to December 2014. To identify the independent risk factors for CALs, multivariable logistic regression models were constructed using significant variables identified from univariate logistic regression analysis.Results:The incidence of CALs was 36.0% (840 of 2331), including 625 (26.8%) coronary artery dilations and 215 (9.2%) coronary artery aneurysms (CAAs). Multivariable logistic regression analysis identified that male, incomplete KD, longer fever duration, and C-reactive protein (CRP) >100 mg/L were independent risk factors for coronary artery dilatations. On the other hand, male, incomplete KD, longer fever duration, prolonged days of illness at the initial treatment, corticosteroid therapy, sodium ≤133 mmol/L, and albumin <35 g/l were the independent risk factors for caas. in addition, corticosteroid therapy, prolonged days of illness at the initial treatment, and albumin <35 g/l were the independent risk factors for giant caas.conclusions:cals might be associated with male sex, incomplete kd, longer fever duration, prolonged days of illness at the initial treatment, albumin <35 g/l, sodium ≤133 mmol/l, crp>100 mg/L, and corticosteroid therapy. Corticosteroid therapy was an independent risk factor for CAAs and giant CAAs. Thus, corticosteroids should be used with caution in the treatment of KD with the risk for CALs.

引自：Chun-Na Zhao,Zhong-Dong Du, Ling-Ling Gao .Corticosteroid Therapy Might be Associated with the Development of Coronary Aneurysm in Children with Kawasaki Disease. Chin Med J (Engl). 2016 Apr 20; 129(8): 922–928.