بررسی اختلالات قلبی- عروقی زودرس و دیررس در کودکان مبتلا به بیماری کاوازاکی و عوامل خطر مرتبط با آن‌ها

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استاد، گروه کودکان، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، گروه کودکان، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی پژوهش‌های دانشجویان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: بیماری کاوازاکی، یک واسکولیت حاد و خود محدود شونده با اتیولوژی نامشخص است. اختلالات قلبی- عروقی، شایع‌ترین عارضه‌ی جدی بیماری کاوازاکی است. هدف از انجام این مطالعه، بررسی اختلالات قلبی- عروقی زودرس و دیررس در کودکان مبتلا به کاوازاکی و عوامل خطر مرتبط با آن‌ها می‌باشد.روش‌ها: این مطالعه‌ی هم‌گروهی گذشته‌نگر، بر روی 85 بیمار مبتلا به کاوازاکی انجام شد. تمامی بیماران تحت اکوکاردیوگرافی قرار گرفتند و همچنین، پرونده‌های بیماران بررسی شد. بیماران به گروه‌های دارای اختلالات قلبی- عروقی زودرس و دیررس و فاقد این اختلالات تقسیم شدند و بر روی داده‌ها آنالیز آماری صورت گرفت.یافته‌ها: شایع‌ترین اختلال قلبی- عروقی زودرس و دیررس به ترتیب، نارسایی میترال (9/45 درصد) و نارسایی تریکوسپید (0/20 درصد) بود. در آنالیز Logistic regression، دریافت دز دوم ایمنوگلوبولین داخل وریدی (IVIG یا Intravenous immunoglobulin) با نسبت شانس 81/2 به عنوان عوامل خطر اختلال قلبی- عروقی زودرس مشخص گردید. همچنین، افراد مبتلا به اختلال قلبی- عروقی در شروع بیماری، شانس بیشتری برای ابتلا به اختلالات قلبی- عروقی دیررس داشتند (نسبت شانس = 23/7 و حدود اطمینان = 8/26-95/1).نتیجه‌گیری: در این مطالعه مشخص گردید که افراد دریافت کننده‌ی دز دوم IVIG در معرض خطر بیشتری برای ابتلا به اختلالات قلبی- عروقی زودرس هستند. ابتلا به اختلالات قلبی- عروقی در مرحله‌ی ابتدایی بیماری، به عنوان عامل خطر اختلالات قلبی- عروقی دیررس مطرح گردید. برای ارزیابی بهتر، مطالعاتی با حجم نمونه‌ی بیشتر و آینده‌نگر پیشنهاد می‌گردد.

کلیدواژه‌ها

عنوان مقاله [English]

Evaluation of Early- and Late-onset Cardiovascular Disorders and Related Risk Factors in Children with Kawasaki Disease

نویسندگان [English]

  • Mohammad Reza Sabri 1
  • Hamid Rahimi 2
  • Seyed Mojtaba Mousavi 3
  • Amin Abedini 3
  • Peyman Roomizadeh 3
  • Farhad Mahmoudi 3
  • Ebrahim Haghighizadeh 3
1 Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, School of Medicine AND Students Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Kawasaki disease is an acute and self-limited vasculitis which has unknown etiology. Cardiovascular disorders (CVDs) are the most common serious complication of this disease. The main aim of this study was the evaluation of early- and late-onset cardiovascular disorders and related risk factors in children with Kawasaki disease.Methods: This historical cohort study was conducted among 85 patients with Kawasaki disease. Echocardiography was performed in all the patients. Besides, medical documents of all the patients were evaluated. Patients were divided in groups with and without early- and late-onset cardiovascular disorders and then, statistical analysis was performed on data.Findings: The most common early- and late-onset cardiovascular disorders were mitral regurgitation (45.9%) and tricuspid regurgitation (20%), respectively. In logistic regression analysis, patients which received second dose of intravenous immunoglobulin (IVIG) showed significantly higher risk of early-onset cardiovascular disorders (OR: 2.81, 95%CI: 1.05-7.51). In addition, patients who had cardiovascular disorders in onset of the disease showed higher risk for late-onset cardiovascular disorders (OR: 7.23, 95%CI: 1.95-26.8).Conclusion: In this study, it was shown that patients who received second dose of IVIG were on higher risk for early onset cardiovascular disorders. Suffering of cardiovascular disorders in initial phase of the disease was proposed as risk factor for late onset these disorders. For better evaluation, studies with larger sample size and prospective design are suggested.

کلیدواژه‌ها [English]

  • Kawasaki disease
  • Cardiovascular disorders
  • Children

مراجع

  1. Newburger JW, Takahashi M, Burns JC. Kawasaki disease. J Am Coll Cardiol 2016; 67(14): 1738-49.
  2. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110(17): 2747-71.
  3. Singh S, Vignesh P, Burgner D. The epidemiology of Kawasaki disease: a global update. Arch Dis Child 2015; 100(11): 1084-8.
  4. Heuclin T, Dubos F, Hue V, Godart F, Francart C, Vincent P, et al. Increased detection rate of Kawasaki disease using new diagnostic algorithm, including early use of echocardiography. J Pediatr 2009; 155(5): 695-9.
  5. Printz BF, Sleeper LA, Newburger JW, Minich LL, Bradley T, Cohen MS, et al. Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol 2011; 57(1): 86-92.
  6. Akagi T, Kato H, Inoue O, Sato N, Imamura K. Valvular heart disease in Kawasaki syndrome: incidence and natural history. Am Heart J 1990; 120(2): 366-72.
  7. Moran AM, Newburger JW, Sanders SP, Parness IA, Spevak PJ, Burns JC, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gamma-globulin. Am Heart J 2000; 139(2 Pt 1): 217-23.
  8. Newburger JW, Sanders SP, Burns JC, Parness IA, Beiser AS, Colan SD. Left ventricular contractility and function in Kawasaki syndrome. Effect of intravenous gamma-globulin. Circulation 1989; 79(6): 1237-46.
  9. Berdej-Szczot E, Firek-Pedras M, Szydlowski L, Krzystolik-Ladzinska J, Klimek K, Malecka-Tendera E. Analysis of risk factors and prospective evaluation of cardiovascular complications of Kawasaki disease in children: a single centre study. Kardiol Pol 2013; 71(12): 1279-86.
  10. Nakamura Y, Yashiro M, Oki I, Tanihara S, Ojima T, Yanagawa H. Giant coronary aneurysms due to Kawasaki disease: a case-control study. Pediatr Int 2002; 44(3): 254-8.
  11. Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, et al. Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2004; 46(1): 33-8.
  12. Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, et al. Case-control study of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2003; 45(4): 410-3.
  13. Sudo D, Monobe Y, Yashiro M, Sadakane A, Uehara R, Nakamura Y. Case-control study of giant coronary aneurysms due to Kawasaki disease: the 19th nationwide survey. Pediatr Int 2010; 52(5): 790-4.
  14. Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986; 108(3): 388-92.
  15. McCrindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116(2): 174-9.
  16. Holve TJ, Patel A, Chau Q, Marks AR, Meadows A, Zaroff JG. Long-term cardiovascular outcomes in survivors of Kawasaki disease. Pediatrics 2014; 133(2): e305-e311.
  17. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94(6): 1379-85.
  18. Asadi-Pooya AA, Borzoee M, Amoozgar H. The experience with 113 patients with Kawasaki disease in Fars Province, Iran. Turk J Pediatr 2006; 48(2): 109-14.
  19. Kordidarian R, Kazemi A, Nikyar A, Torfeh Nejad M. Assessing Kawasaki disease in children at Alzahra hospital (1995-1999). J Qazvin Univ Med Sci 2008; 11(4): 42-7. [In Persian].
  20. Shamsizadeh A, Ziaei KT, Razavi M, Cheraghian B. Clinical and epidemiological characteristics of kawasaki disease. Jundishapur J Microbiol 2014; 7(8): e11014.
  21. Amirimoghadam Z, Molaee S, Rezazadeh M, Ghaneei Z, Babaei Haidarabadi A, Hemati R. Assessment Heart Involvement in Patients With Kawasaki Disease. J Ilam Univ Med Sci 2013; 21(1): 129-34. [In Persian].
  22. Jibiki T, Terai M, Kurosaki T, Nakajima H, Suzuki K, Inomata H, et al. Efficacy of intravenous immune globulin therapy combined with dexamethasone for the initial treatment of acute Kawasaki disease. Eur J Pediatr 2004; 163(4-5): 229-33.
  23. Newburger JW, Sleeper LA, McCrindle BW, Minich LL, Gersony W, Vetter VL, et al. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med 2007; 356(7): 663-75.
  24. Suzuki A, Kamiya T, Tsuchiya K, Sato I, Arakaki Y, Kohata T, et al. Tricuspid and mitral regurgitation detected by color flow Doppler in the acute phase of Kawasaki disease. Am J Cardiol 1988; 61(4): 386-90.
  25. Gidding SS, Duffy CE, Pajcic S, Berdusis K, Shulman ST. Usefulness of echocardiographic evidence of pericardial effusion and mitral regurgitation during the acute stage in predicting development of coronary arterial aneurysms in the late stage of Kawasaki disease. Am J Cardiol 1987; 60(1): 76-9.
  26. Baer AZ, Rubin LG, Shapiro CA, Sood SK, Rajan S, Shapir Y, et al. Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome. Arch Pediatr Adolesc Med 2006; 160(7): 686-90.
  27. Al-Ammouri I, Al-Wahsh S, Khuri-Bulos N. Kawasaki disease in Jordan: demographics, presentation, and outcome. Cardiol Young 2012; 22(4): 390-5.
  28. Ozdemir H, Ciftci E, Tapisiz A, Ince E, Tutar E, Atalay S, et al. Clinical and epidemiological characteristics of children with Kawasaki disease in Turkey. J Trop Pediatr 2010; 56(4): 260-2.
  29. Abushaban L, Salama A, Uthaman B, Kumar A, Selvan J. Do we have a less severe form of Kawasaki disease or is it the gammaglobulin effect? Int J Cardiol 1999; 69(1): 71-6.
  30. Scott JS, Ettedgui JA, Neches WH. Cost-effective use of echocardiography in children with Kawasaki disease. Pediatrics 1999; 104(5): e57.
  31. Lee MH, Dai ZK, Lee MS, Hsu JH, Chuang HY, Wu JR. The recommended frequency of echocardiography in follow-up evaluation of patients with Kawasaki disease. Acta Paediatr Taiwan 2005; 46(6): 346-51.
مجله دانشکده پزشکی اصفهان
دوره 34، شماره 396 - شماره پیاپی 396
مهر و آبان 1395
صفحه 998-1006

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سابقه مقاله

  • تاریخ دریافت: 01 خرداد 1395
  • تاریخ بازنگری: 06 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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