https://scholars.lib.ntu.edu.tw/handle/123456789/525243
標題: | Outcomes of Kawasaki disease children with spontaneous defervescence within 10 days | 作者: | YA-CHIAO HU Liu H.-M. MING-TAI LIN CHUN-AN CHEN SHUENN-NAN CHIU CHUN-WEI LU LUAN-YIN CHANG JOU-KOU WANG MEI-HWAN WU |
公開日期: | 2019 | 出版社: | Frontiers Media S.A. | 卷: | 7 | 期: | APR | 來源出版物: | Frontiers in Pediatrics | 摘要: | Background Kawasaki disease (KD) is one of the most common vasculitis in childhood. Intravenous γ-immunoglobulin (IVIG) is recommended to be administrated within 10 days after fever onset. However, some patients didn't have IVIG therapies because of atypical disease presentations or spontaneous defervescence. We aimed to evaluate the coronary outcomes of the KD patients who didn't receive IVIG and had defervescence within 10 days. Methods We retrospectively reviewed the KD patients in NTUCH between 2008 and 2015. The patients with a diagnosis of KD and had a febrile length between 5 to 10 days were enrolled. Days of fever, clinical symptoms, laboratory data at the acute stage and series of coronary artery measurements within a minimum of 3 months after disease onset were recorded. Risk factors associated with coronary lesions one month after KD onset were also analyzed. Results 293 eligible KD patients were enrolled (Male: 55.1%, mean age of onset: 1.8 years old). 37 patients had spontaneous defervescence without IVIG treatment. The incidence of coronary aneurysms at the 4th week after disease onset was higher in spontaneously defervesced KD patients than those treated with IVIG (18.9% vs. 20.3%, p = 0.002). Interestingly, of the 238 KD patients without coronary lesions at their acute phase, percentages of emerging coronary aneurysms became significantly higher if they didn't have IVIG therapies due to spontaneous defervescence (4/31), compared with those who received IVIG (3/208). Further analysis showed the development of coronary lesions at one month after disease onset was associated with younger age (< 12 months old, p = 0.024), and leukocytosis (WBC > 17,000/cumm, p = 0.031). Conclusions: 18.9% of KD patients with spontaneous defervescence had coronary aneurysms. Even without initial coronary lesions, such patients were still riskier to develop coronary aneurysms, compared with KD patients who received IVIG therapies. Such findings address the importance of refining the strategy for use of IVIG in the spontaneously defervesced KD patients within 10 days after fever onset, at least in those with age younger than one year and those with leukocytosis. ? 2019 Hu, Liu, Lin, Chen, Chiu, Lu, Chang, Wang and Wu. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064680444&doi=10.3389%2ffped.2019.00158&partnerID=40&md5=644a01bca43ba4640ea4bcaf5eb58f5f https://scholars.lib.ntu.edu.tw/handle/123456789/525243 |
ISSN: | 2296-2360 | DOI: | 10.3389/fped.2019.00158 | SDG/關鍵字: | aspartate aminotransferase; C reactive protein; hemoglobin; immunoglobulin; Article; aspartate aminotransferase blood level; child; clinical feature; clinical outcome; comparative study; controlled study; coronary artery; coronary artery aneurysm; coronary artery disease; female; fever; hemoglobin blood level; human; incidence; left anterior descending coronary artery; left coronary artery; leukocytosis; major clinical study; male; mucocutaneous lymph node syndrome; onset age; preschool child; retrospective study; risk factor |
顯示於: | 醫學系 |
在 IR 系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。