Analysis of laboratory indexes and ultrasonic features of patients with Kawasaki disease shock syndrome / 中华实用儿科临床杂志

ABSTRACT

Objective@#To retrospectively analyze the laboratory findings and ultrasonographic features in acute phase of children suffering from Kawasaki disease (KD) with stable hemodynamics and Kawasaki disease shock syndrome (KDSS), so as to provide the evidence for early diagnosis, timely treatment and improvement of prognosis of KDSS.@*Methods@#Four hundred and eighteen patients with KD diagnosed at Shenzhen Children′s Hospital from November 2016 to May 2018 were selected, including 23 KDSS patients(KDSS group) and 395 cases with stable hemodynamic(KD without shock group). The clinical characteristics, laboratory index and ultrasonic examination data of the 2 groups were collected and compared for statistical conclusion.@*Results@#(1)The level of C-reaction protein(CRP)[166.20 mg/L (74.40 mg/L)], γ-glutamyl transpeptidase(γ-GT)[88.00 IU/L (126.00 IU/L)], creatine kinase isoenzyme(CKI)[1.78 μg/L (5.17 μg/L)], troponin(TP)[0.01 μg/L (0.39 μg/L)] in the KDSS group in acute phase were all higher than those in the KD without shock group[70.50 mg/L (54.30 mg/L), 40.00 IU/L (89.00 IU/L), 1.20 μg/L (0.85 μg/L), 0.01 μg/L (0.01 μg/L)], hemoglobin(Hb)[90.00 g/L (15.00 g/L)], ablumin [24.20 g/L (4.30 g/L)], serum sodium[130.90 mmol/L (5.60 mmol/L)] levels in the KDSS group were lower than those in the KD without shock group[107.00 g/L (14.00 g/L), 33.40 g/L (4.08 g/L), 136.10 mmol/L (3.25 mmol/L)], and the differences were statistically significant (all P<0.05). (2)The incidence rates of impaired left ventricular ejection fraction(LVEF)[<55% 3 cases (13.03%) vs.8 cases (2.00%)], coronary artery abnormalities[left anterior descending branch(LAD) Z-score>2.5 6 cases (26.09%) vs.35 cases (8.86%)]and valvular regurgitation[tricuspid regurgitation(TR)≥moderate 3 cases (13.03%) vs.5 cases (1.26%)]in the KDSS group were higher than those in the KD without shock group, and the differences were statistically significant (all P<0.05). (3)Among acute phase in KDSS group, 9 cases (39.13%) had liver enlargement, 9 cases (39.13%) had peritoneal effusion, 3 cases (13.04%) had diffuse renal lesions, 3 cases (13.04%) had joint effusion (2 cases of knee joint effusion, 1 case of hip joint effusion), and 2 cases (8.70%) had enteritis.In the KD without shock group, only 3 cases (0.76%) had hepatomegaly and 2 cases (0.51%) had a small amount of knee effusion.@*Conclusions@#Laboratory findings of KDSS group showed higher level of CRP, CKI, TP as well as γ-GT than those in KD without shock group, who are more prone to suffer from hypohemoglobin, hyponatremia and hypoalbuminemia.Ultrasound examination showed that KDSS children were more prone to have heart or multiple-organ damage.Clinicians should raise their awareness to provide comprehensive assessment as well as timely and effective treatment.