ObjectiveTo systematically review the response of Kawasaki disease (KD) after an initial standard dose of intravenous immunoglobulin (IVIG) therapy and routine laboratory indexes.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases to collect case-control studies about the correlation between response of KD after an initial standard dose of IVIG therapy and routine laboratory indexes till 31st December 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. A meta-analysis was performed by using RevMan 5.3 software.ResultsThirty studies were included. The results of meta-analysis demonstrated that the levels of hemoglobin (Hb) (SMD=–0.21, 95%CI –0.32 to –0.09, P<0.001), serum albumin (ALB) (SMD=–0.68, 95%CI –0.90 to –0.47,P<0.001) and serum sodium (SMD=–0.64, 95%CI –1.01 to –0.27,P<0.001) in IVIG non-responsiveness group were significantly lower than those in IVIG responsiveness group. The levels of alanine aminotransferase (ALT) (SMD=0.74, 95%CI 0.36 to 1.13,P<0.001), aspartate aminotransferase (AST) (SMD=0.61, 95%CI 0.24 to 0.99,P=0.001) and C-reactive protein (CRP) (SMD=0.63, 95%CI 0.38 to 0.87, P<0.001) in IVIG non-responsiveness group were higher than those in the IVIG responsiveness group.ConclusionThe current evidence shows that low levels of Hb, ALB and serum sodium and high levels of CRP, ALT, and AST are risk factors of IVIG non- responsiveness in KD. Due to limited quality and quantity of included studies, more high-quality studies are needed to verify the conclusion.
目的 探討川崎病（Kawasaki disease，KD）患兒血脂代謝與冠狀動脈病變之間的關系。 方法 納入2007年1月-2009年10月住院治療的82例KD患兒，檢測治療前后血總膽固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）、極低密度脂蛋白（VLDL-C）、載脂蛋白A1（ApoA1）及載脂蛋白B100（ApoB100）水平。選取50例健康兒童作為對照。KD患兒在治療前行超聲心動圖檢查，根據超聲心動圖顯示將KD組再分為冠狀動脈病變組（CAL組，n=31）和非冠狀動脈病變組（NCAL，n=51）。 結果 治療前，KD患兒TC、ApoA1、HDLC降低，TG、LDL-C升高，與正常兒童相比有統計學意義（Plt;0.05）。KD患兒CAL組較NCAL組變化更明顯，有統計學意義（Plt;0.05）。VLDL-C和ApoB100水平KD患兒與正常兒童比較、NCAL組與CAL組比較變化均不明顯（Pgt;0.05）。治療后與治療前相比，NCAL組TC、TG、HDL-C、LDL-C、ApoA1恢復正常（Plt;0.05）），而CAL組僅TC、LDL-C、ApoA1恢復正常（Plt;0.05）。 結論 KD患兒存在血脂代謝紊亂，TC、TG、HDL-C、LDL-C、ApoA1與冠狀動脈的損害有關，應早期進行干預。
Objective To analyze the timing and mid-term prognosis of bypass surgery for children with Kawasaki disease complicated with coronary artery aneurysms. Methods A retrospective analysis was conducted on the clinical data of children with Kawasaki disease complicated with coronary artery aneurysms who underwent coronary artery bypass grafting at Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from March 2018 to December 2023. Results Finally, 20 pediatric patients were enrolled, including 16 males and 4 females, with a median age of 118 (74, 140) months. All patients who failed drug treatment and had progressive coronary artery dilation with thrombosis underwent bypass surgery, including 14 patients with cardiac arrest and 6 patients without cardiac arrest. One patient died of severe left heart failure. The median follow-up of 19 surviving children was 34 (16, 61) months, and 84.2% of them had electrocardiogram recovery. The coronary artery diameter decreased from (16.2±9.2) mm to (8.2±2.7) mm, and the left ventricular ejection fraction increased from (58.2±8.6)% to (63.8±7.0)%. The 89.4% (17/19) of the patients’ vessels were unobstructed, and 94.7% (18/19) of the heart function recovered to grade Ⅰ/Ⅱ. Conclusion Coronary artery bypass grafting is safe and effective for treating Kawasaki disease coronary artery aneurysms in children, with a good mid-term prognosis.
Objective To provide evidence for timely diagnosis and treatment of Kawasaki disease through assessing the relationship between the duration of fever and the incidence of coronary artery lesion in patients with Kawasaki disease. Methods To retrospectively analyze the clinical information of 352 inpatients with Kawasaki disease (including typical Kawasaki disease, incomplete Kawasaki disease, and non-responsive to intravenous immunoglobulin treatment Kawasaki disease ) from January 1997 to December 2007. The relationship between the duration of fever and the incidence of coronary artery lesion was presented by a linear trend plot, using Cochran-Armitage trend test. A value of P lt; 0.05 was considered statistically significant. Results Among 352 patients with Kawasaki disease, 88 had coronary artery lesions. Sixty-eight out of 294 patients with typical Kawasaki disease, 20 out of 58 patients with incomplete Kawasaki disease, and 18 out of 44 patients with non-responsive Kawasaki disease had coronary artery lesions. Linear trend analysis showed that the duration of fever in all 352 patients with Kawasaki disease and 294 cases with typical Kawasaki disease was positively correlated with the incidence of coronary artery lesion (Plt;0.05). However, in patients with incomplete Kawasaki disease and non-responsive Kawasaki disease, the relationship between the duration of fever and the incidence of coronary artery lesion was not significant (Pgt; 0.05). Conclusion The longer the duration of fever was in patients with Kawasaki disease, higher the risk of coronary artery lesion.
Objective To analysis the research status and hotspot in the field of Kawasaki disease (KD) in recent 10 years. Methods The relevant documents included in the core database of Web of Science from 2010 to 2021 were searched, to analyze the cooperation relationship among authors, countries and institutions by CiteSpace software, analyze the co-occurrence, cluster analysis, dynamic frontier evolution and emergence of keywords, analyze the co citation of cited journals and documents, draw a visual map and analyze. Result A total of 3 041 articles were included, and there were 114 core authors. USA was the core country in the research field of KD, while China occupied a place. University of California, San Diego and Montreal University were the core research institutions. Circulation was the core journal. Keywords formed 7 clusters, and there were a total of 62 emergent words. Conclusions In the past 10 years, the research on KD has shown an upward trend. The research hot spots focus on the diagnosis and treatment, management, pathogenesis, epidemiological research of KD, and the research on Kawasaki-like diseases during the coronavirus disease 2019. Predicting the long-term management of KD, related research on intravenous immunoglobulin resistance and cytokines are the research frontiers in this field.