川崎病合并肝功能损害的影响因素分析

舒中宇; 邓芳; 杨舒馨影

doi:10.16766/j.cnki.issn.1674-4152.002945

川崎病合并肝功能损害的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002945

1.
复旦大学附属儿科医院安徽医院儿内科，安徽合肥 230051
2.
中国科学技术大学附属第一医院南区检验科，安徽合肥 230031

基金项目:

安徽省重点研究与开发技术项目 202004j07020028

详细信息

通讯作者:
舒中宇, E-mail: shuzhongyudoctor@163.com

中图分类号: R725.9
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-28
- 网络出版日期: 2023-05-31

Analysis of the influencing factors of Kawasaki disease combined with liver function impairment

1.
Internal Medicine, Anhui Hospital, Pediatric Hospital Affiliated to Fudan University, Hefei, Anhui 230051, China

摘要

摘要: 目的分析川崎病合并肝功能损害的临床特征，探讨可能影响川崎病合并肝脏功能损害的因素。方法收集复旦大学附属儿科医院安徽医院2020年1—12月收治的300例川崎病患儿的临床资料，根据是否有肝脏功能损害，将患儿分为肝功能正常组[181例(60.3%)]和肝功能异常组[119例(39.7%)]。比较2组患儿年龄、性别、入院时血清总胆红素(TBIL)、血清白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、红细胞沉降率(ESR)、降钙素原(PCT)、白细胞总数(WBC)、血小板计数(PLT)、C反应蛋白(CRP)，并纳入PLT、PCT、CRP行二元logistic回归分析。结果 300例川崎病患儿中，男189例(63.0%)，女111例(37.0%)，男女比例为1.7∶ 1；年龄最小2个月，最大9岁，年龄中位数为2岁。肝功能异常组 < 1岁45例(37.8%)，2~3岁54例(45.4%)，4~5岁12例(10.1%)，>6岁8例(6.7%)；部分患儿临床表现为轻度消化道症状，其中呕吐8例(2.7%)、腹泻6例(2.0%)、腹痛2例(0.7%)、肝肿大1例(0.3%)。2组年龄、性别等一般资料比较，差异均无统计学意义(均P>0.05)；肝功能异常组的ALT、AST、ALB、GGT、TBIL、PLT、PCT、CRP显著高于肝功能正常组，差异有统计学意义(均P < 0.05)。纳入PLT、PCT、CRP行二元logistic回归分析，结果显示，PLT、PCT、CRP均为川崎病患儿肝功能异常的影响因素(均P＜0.05)。结论血小板、降钙素原、C反应蛋白增高是川崎病合并肝功能损害的危险因素。
- 川崎病 /
- 肝功能损害 /
- 临床特点
Abstract: Objective This study aims to analyze the clinical features of Kawasaki disease (KD) with liver function impairment, and to explore the possible influencing factors of it. Methods The clinical data of 300 children with KD in Anhui Pediatric Hospital of Fudan University, ranging from January 2020 to December 2020, were collected. According to the presence or absence of liver function impairment, the children were divided into normal liver function group [181 cases (60.3%)] and abnormal liver function group [119 cases (39.7%)].The age, gender, total serum bilirubin (TBIL), serum albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), erythrocyte sedimentation rate (ESR), calcitoninogen (PCT), total white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP) of the children in the 2 groups were compared, PLT, PCT and CRP were included in the binary logistic regression analysis. Results Of the 300 children with KD, 189 (63.0%) were male and 111 (37.0%) were female, and the male-to-female ratio was 1.7∶ 1; The minimum age was 2 months, and the maximum age was 9 years, with a median age of 2 years; There were 45 cases (37.8%) under 1 years old, 54 cases (45.4%) were 2-3 years old, 12 cases (10.1%) were 4-5 years old, and 8 cases more than 6 years old (6.7%) in the group with abnormal liver function. Some children showed mild gastrointestinal symptoms. There were 8 children with vomiting (2.7%), 6 with diarrhea (2.0%), 2 with abdominal pain (0.7%) and 1 with hepatomegaly (0.3%). Compared the general data such as age and gender, the differences were not statistically significant (all P>0.05); ALT, AST, ALB, GGT, TBIL, PLT, PCT, CRP were significantly higher in the group with abnormal liver function than in the group with normal liver function, the differences were statistically significant (all P < 0.05). PLT, PCT and CRP were included in the binary logistic regression analysis. The results showed that PLT, PCT and CRP were all influencing factors of abnormal liver function in children with KD (all P < 0.05). Conclusion Increased PLT, PCT and CRP are risk factors for KD combined with liver function impairment.
- Kawasaki disease /
- Liver function impairment /
- Clinical features

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表 1 2组川崎病患儿一般资料及实验室指标比较

Table 1. Comparison of general information and laboratory indicators between two groups of children with Kawasaki disease

项目	肝功能异常组(n=119)	肝功能正常组(n=181)	统计量	P值
性别(男/女, 例)	73/46	116/65	0.232^a	0.630
CRP[M(P₂₅, P₇₅), mg/L]	45.0(26.4, 73.0)	77.0(50.0, 106.0)	-5.026^b	<0.001
PLT[M(P₂₅, P₇₅), 10⁹/L]	326.0(265.5, 403.0)	355.0(281.0, 442.0)	-2.259^b	0.024
WBC[M(P₂₅, P₇₅), 10⁹/L]	14.7(11.9, 17.4)	14.2(11.0, 17.0)	-0.792^b	0.428
ESR[M(P₂₅, P₇₅), mm/h]	54.0(31.0, 77.0)	59.0(35.8, 83.0)	-1.054^b	0.292
ALB[M(P₂₅, P₇₅), U/L]	39.0(36.0, 42.0)	36.0(33.0, 39.0)	-5.703^b	<0.001
ALT[M(P₂₅, P₇₅), U/L]	18.0(12.0, 25.0)	54.0(18.0, 136.3)	-7.819^b	<0.001
年龄[例(%)]
≤1岁	45(37.8)	59(32.6)	1.242^b	0.743
2~3岁	54(45.4)	91(50.3)
4~5岁	12(10.1)	21(11.6)
≥6岁	8(6.7)	10(5.5)
PCT[M(P₂₅, P₇₅), ng/mL]	0.2(0.1, 0.4)	0.6(0.2, 1.6)	-5.983^b	<0.001
AST[M(P₂₅, P₇₅), U/L]	28.4(23.0, 36.0)	37.5(24.2, 85.5)	-4.466^b	<0.001
GGT[M(P₂₅, P₇₅), U/L]	15.5(11.0, 24.3)	62.0(20.0, 136.8)	-8.973^b	<0.001
TBIL[M(P₂₅, P₇₅), U/L]	6.0(4.5, 8.0)	8.0(5.4, 12.0)	-4.622^b	<0.001
注：^a为χ²值，^b为Z值。

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表 2 川崎病合并肝功能损害影响因素分析

Table 2. Analysis of influencing factors of Kawasaki disease combined with liver function damage

变量	B	SE	Wald	P值	OR值	95% CI
PLT	0.004	0.001	7.904	0.005	1.004	1.001~1.006
PCT	0.658	0.212	9.637	0.002	1.930	1.274~2.924
CRP	0.007	0.003	4.475	0.034	1.007	1.001~1.014

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