perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”perinatology-160Research ArticleКАРДИОЛОГИЯ И РЕВМАТОЛОГИЯКАРДИОЛОГИЯ И РЕВМАТОЛОГИЯФакторы риска поражения коронарных артерий при синдроме КавасакиKawasaki syndrome: Risk factors for coronary artery aneurysmsТорбякА. В.TorbyakA. V.

асп. каф. детских болезней лечебного факультета Первого Московского государственного медицинского университета им. И.М. Сеченова; врач-кардиолог окружного консультативно-диагностического центра

ШиринскаяО. Г.ShirinskayaO. G.

к.м.н., врач ультразвуковой диагностики отделения ультразвуковой диагностики Университетской детской клинической больницы, стн.с. НИО Проблем педиатрии НИЦ того же учреждения

ЛыскинаГ. А.LyskinaG. A.

д.м.н., проф. каф. детских болезней лечебного факультета того же учреждения

ЛеонтьеваА. А.LeontyevaA. A.

врач ультразвуковой диагностики отделения ультразвуковой диагностики Университетской детской клинической больницы того же учреждения

ПруцковаЕ. В.PrutskovaE. V.

н.с. научной лаборатории «Социология религии», преподаватель кафедры философии религии и религиозных аспектов культуры, Православного Свято-Тихоновского гуманитарного университета; ассоциированный сотрудник ЛССИ, Национального исследовательского университета «Высшая школа экономики»

МелкумянЕ. Б.MelkumyanE. B.

н.с. той же лаборатории 115184 Москва, ул. Новокузнецкая, д. 23Б

ГБОУВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова», Москва; Национальный исследовательский университет «Высшая школа экономики», Москва; Православный Свято-Тихоновский гуманитарный университетРоссияI.M. Sechenov First Moscow State Medical University, Moscow; Higher School of Economics, National Research University; Saint Tikhon's Orthodox University of Humanities, MoscowRussian Federation2015140320166057984Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20162016Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/160

Синдром Кавасаки - системный васкулит детского возраста, при котором могут поражаться коронарные артерии, что в дальнейшем может привести к ишемии миокарда, инфаркту миокарда. Настоящее исследование представляет первый в нашей стране опыт применения регрессионного анализа для поиска факторов риска поражения коронарных артерий при синдроме Кавасаки. Ретроспективно проанализированы данные амбулаторных карт и выписок из историй болезни 168 пациентов с синдромом Кавасаки, возраст больных от 1 мес 13 дней до 13 лет 6 мес. Выделены факторы риска поражения коронарных артерий: продолжительная лихорадка, длительная лихорадка до введения иммунного глобулина, низкий гемоглобин в острую фазу, лейкоцитоз в острую фазу больше 17-109/л, тромбоцитоз более 790-109/л и выраженное увеличение СОЭ, повышение уровня С-реактивного белка более 5 норм, введение иммунного глобулина после 10-го дня, отсутствие терапии иммунным глобулином. Доза иммунного глобулина 2 г/кг снижает риск образования аневризм коронарных артерий, но ее эффект зависит от дня введения. Шейная лимфаденопатия и резистентность к иммунному глобулину могут быть факторами риска формирования аневризм коронарных артерий, но для решения этого вопроса нужны дальнейшие исследования.

Kawasaki syndrome is a childhood systemic vasculitis that may affect coronary arteries, further leading to myocardial ischemia or myocardi-al infarction. This investigation is our country's first experience with regression analysis to find risk factors for coronary artery involvement in Kawasaki syndrome. The outpatient and inpatient medical records of 168 KD patients aged 1 month 13 days to 13 years 6 months were retrospectively analyzed. Results. The investigators revealed risk factors for coronary artery involvement: persistent fever; prolonged fever prior to immunoglobulin infusion; low hemoglobin in acute phase; leukocytosis more than 17* 109/l in acute phase; thrombocytosis more than 790-109/! and obviously increased erythrocyte sedimentation rate; a more than 5-fold rise in normal C-reactive protein; immunoglobulin administration after day 10; and no immunoglobulin therapy. The dose of immunoglobulin of 2 g/kg reduces the risk of coronary artery aneurysms, but its effect depends on the day of administration. Cervical lymphadenopathy and immunoglobulin resistance may be risk factors for coronary artery aneurysms, but further investigations are needed to solve this problem.

детисиндром Кавасакипоражение коронарных артерийаневризмы коронарных артерийфакторы риска.childrenKawasaki syndromecoronary artery involvementcoronary artery aneurysmsrisk factors.ReferencesKato ТТ., Sugimura Т., Akagi Т. et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94: 6: 1379-1385.Kato ТТ., Sugimura Т., Akagi Т. et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94: 6: 1379-1385.Tsuda E. Long-term management in patients after Kawasaki disease — sudden death, fatal arrhythmia, and myocardial dysfunction. Abstracts of the 10th International Kawasaki Disease Symposium. February 7—10, 2012. Kyoto, Japan. Pediatrics International 2012; 54: Suppl 1: 38-142.Tsuda E. Long-term management in patients after Kawasaki disease — sudden death, fatal arrhythmia, and myocardial dysfunction. Abstracts of the 10th International Kawasaki Disease Symposium. February 7—10, 2012. Kyoto, Japan. Pediatrics International 2012; 54: Suppl 1: 38-142.ChoM.A, Choi Y.J., JungJ.W. Affects of "age at diagnosis" on coronary artery lesions in patients with incomplete Kawasaki disease. Korean Circ J 2010; 40: 6: 283-287.ChoM.A, Choi Y.J., JungJ.W. Affects of "age at diagnosis" on coronary artery lesions in patients with incomplete Kawasaki disease. Korean Circ J 2010; 40: 6: 283-287.Taubert K.A., Rowley A.H., Shulman S.T. Nationwide survey of Kawasaki disease and acute rheumatic fever. J Pediat 1991; 119: 279-282.Taubert K.A., Rowley A.H., Shulman S.T. Nationwide survey of Kawasaki disease and acute rheumatic fever. J Pediat 1991; 119: 279-282.Daniels L.B., Tjajadi M.S., Walford TT.TT. et al. Prevalence of Kawasaki disease in young adults with suspected myocardial ischemia. Circulation 2012; 125: 2447-2453.Daniels L.B., Tjajadi M.S., Walford TT.TT. et al. Prevalence of Kawasaki disease in young adults with suspected myocardial ischemia. Circulation 2012; 125: 2447-2453.Nakamura Y, Yashiro M., Uehara R. et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2009—2010 nationwide survey. J Epidemiol 2012; 22: 216—221.Nakamura Y, Yashiro M., Uehara R. et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2009—2010 nationwide survey. J Epidemiol 2012; 22: 216—221.Zhang Т., Yanagawa ТТ., Oki I, Nakamura Y. Factors relating to the cardiac sequelae of Kawasaki disease one month after initial onset. Acta Pediat 2002; 91: 517-520.Zhang Т., Yanagawa ТТ., Oki I, Nakamura Y. Factors relating to the cardiac sequelae of Kawasaki disease one month after initial onset. Acta Pediat 2002; 91: 517-520.Лыскина I.А., Торбяк А.В. Клинические особенности синдрома Кавасаки у детей, заболевших в возрасте до 6 мес. Рос вестн перинатол и педиат 2014; 59: 6: 32—39 (Lyskina G.A., Torbyak A.V. Clinical features of Kawasaki syndrome in infants younger than six months of age. Ros vestn perinatal i pediat2014;59:6:32-39.)Лыскина I.А., Торбяк А.В. Клинические особенности синдрома Кавасаки у детей, заболевших в возрасте до 6 мес. Рос вестн перинатол и педиат 2014; 59: 6: 32—39 (Lyskina G.A., Torbyak A.V. Clinical features of Kawasaki syndrome in infants younger than six months of age. Ros vestn perinatal i pediat2014;59:6:32-39.)Belay E.D., Maddox R.A., Holman R.C. et al. Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003. Pediat Infect Dis J 2006; 25: 3: 245-249.Belay E.D., Maddox R.A., Holman R.C. et al. Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003. Pediat Infect Dis J 2006; 25: 3: 245-249.Pannaraj P.S., Turner СТ., Bastian J.F., Burns J.C. Failure to diagnose Kawasaki disease at the extremes of the pediatric age range. Pediat Infect Dis J 2004; 23: 8: 789-791.Pannaraj P.S., Turner СТ., Bastian J.F., Burns J.C. Failure to diagnose Kawasaki disease at the extremes of the pediatric age range. Pediat Infect Dis J 2004; 23: 8: 789-791.Muta ТТ., Ishii M., Sakaue T. et al. Older age is a risk factor for the development of cardiovascular sequelae in Kawasaki disease. Pediatrics 2004; 114: 3: 751-754.Muta ТТ., Ishii M., Sakaue T. et al. Older age is a risk factor for the development of cardiovascular sequelae in Kawasaki disease. Pediatrics 2004; 114: 3: 751-754.Nakamura Y, Oki T, Tanihara S. et al. Cardiac sequelae in recurrent cases of Kawasaki Disease: A comparison between the initial episode of the disease and a recurrence in the same patients. Pediatrics 1998; 102: e66.Nakamura Y, Oki T, Tanihara S. et al. Cardiac sequelae in recurrent cases of Kawasaki Disease: A comparison between the initial episode of the disease and a recurrence in the same patients. Pediatrics 1998; 102: e66.Muta ТТ., Ishii M., Yashiro M. et al. Late intravenous immuno-globulin treatment in patients with Kawasaki disease. Pediatrics 2012; 129: e291-297.Muta ТТ., Ishii M., Yashiro M. et al. Late intravenous immuno-globulin treatment in patients with Kawasaki disease. Pediatrics 2012; 129: e291-297.Nakamura Y, YashiroM., Uehara R. etal. Case-control study of giant coronary aneurysms due to Kawasaki disease. Pediat Int 2003; 45: 4: 410-413.Nakamura Y, YashiroM., Uehara R. etal. Case-control study of giant coronary aneurysms due to Kawasaki disease. Pediat Int 2003; 45: 4: 410-413.Sudo D., Monobe Y., Yashiro M. et al. Case-control study of giant coronary aneurysms due to Kawasaki disease: The 19th nationwide survey. Pediat Int 2010; 52: 790-794.Sudo D., Monobe Y., Yashiro M. et al. Case-control study of giant coronary aneurysms due to Kawasaki disease: The 19th nationwide survey. Pediat Int 2010; 52: 790-794.UeharaR., Belay E.D., MaddoxR.A. etal. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediat Infect Dis J 2008; 27: 155-160.UeharaR., Belay E.D., MaddoxR.A. etal. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediat Infect Dis J 2008; 27: 155-160.Yellen E.S., Gauvreau K., Takahashi M. et al. Performance of 2004 American Heart Association Recommendations for Treatment of Kawasaki Disease. Pediatrics 2010; 125: 2: e234-e241.Yellen E.S., Gauvreau K., Takahashi M. et al. Performance of 2004 American Heart Association Recommendations for Treatment of Kawasaki Disease. Pediatrics 2010; 125: 2: e234-e241.Newburger J.W., Takahashi M., Gerber M.A. 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 Hearth Association. Circulation 2004; 110: 17: 2747-2771.Newburger J.W., Takahashi M., Gerber M.A. 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 Hearth Association. Circulation 2004; 110: 17: 2747-2771.Лыскина Г.А, Ширинская О.Г. Слизисто-кожный лимфоно-дулярный синдром (синдром Кавасаки). Диагностика и лечение. М: Видар-М2008; 144. (LyskinaGA., ShirinskayaO.G. Mucocutaneous lymph node syndrome (Kawasaki syndrome). Diagnostics and therapy. Moscow: Vidar-M 2008; 144.)Лыскина Г.А, Ширинская О.Г. Слизисто-кожный лимфоно-дулярный синдром (синдром Кавасаки). Диагностика и лечение. М: Видар-М2008; 144. (LyskinaGA., ShirinskayaO.G. Mucocutaneous lymph node syndrome (Kawasaki syndrome). Diagnostics and therapy. Moscow: Vidar-M 2008; 144.)Uehara R., Belay E.D. Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol 2012; 22: 79-85.Uehara R., Belay E.D. Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol 2012; 22: 79-85.McCrindle B.W., LiJ.S., Minich L.L. etal. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116:2:174-179.McCrindle B.W., LiJ.S., Minich L.L. etal. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116:2:174-179.Nakamura Y, YashiroM., UeharaR. et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2009—2010 nationwide survey. J Epidemiol 2012; 22: 3: 216—221.Nakamura Y, YashiroM., UeharaR. et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2009—2010 nationwide survey. J Epidemiol 2012; 22: 3: 216—221.Stockheim J.A., Innocentini N., Shulman S.T. Kawasaki disease in older children and adolescents. J Pediat 2000; 137: 2: 250-252.Stockheim J.A., Innocentini N., Shulman S.T. Kawasaki disease in older children and adolescents. J Pediat 2000; 137: 2: 250-252.Momenah Т., SanataniS., Potts J. etal. Kawasaki disease in the older child. Pediatrics 1998; 102: e7.Momenah Т., SanataniS., Potts J. etal. Kawasaki disease in the older child. Pediatrics 1998; 102: e7.

The authors declare that there are no conflicts of interest present.