Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical significance of follow-up laboratory tests, performed at 6 weeks after the onset of Kawasaki disease

가와사끼병에서 발병 6주째에 시행하는 추적검사의 임상적 유용성에 관한 고찰

  • Oh, Il Ji (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Moon, Kyung Hee (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Hong, Myung Eun (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Kim, Yeon Soon (Wonkwang Health Science College) ;
  • Lee, Chang Woo (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Yoon, Hyang Suk (Department of Pediatrics, Wonkwang University School of Medicine)
  • 오일지 (원광대학교 의과대학 소아과학교실) ;
  • 문경희 (원광대학교 의과대학 소아과학교실) ;
  • 홍명은 (원광대학교 의과대학 소아과학교실) ;
  • 김연순 (원광보건대학원) ;
  • 이창우 (원광대학교 의과대학 소아과학교실) ;
  • 윤향석 (원광대학교 의과대학 소아과학교실)
  • Received : 2006.01.02
  • Accepted : 2006.03.20
  • Published : 2006.06.15
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Abstract

Purpose : Low dose aspirin is used due to its antiplatelet effect for the subacute phase of Kawasaki disease(KD). It is usually used for 6-8 weeks, then various hematologic laboratory tests and follow up echocardiography for evaluating coronary abnormalities are performed. Our review investigated the usefulness of various follow up laboratory tests performed at 6 weeks after the onset of KD. Methods : Two hundred eighty-two children diagnosed and hospitalized with KD were identified by reviewing patient's charts. Cases which were diagnosed between January 1997 and December 2004 were included in this study. We reviewed laboratory data including leukocytes, platelet counts, antistreptolysin O(ASO), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), urinalysis, and echocardiograms performed at admission and 6 weeks after the onset of KD. Paired t-test and Fisher's exact test, as well as logistic regression tests, were used for the statistical analysis. Results : At 6th week data, ESR and CRP were still elevated in 35(12.4 percent) and 12(4.3 percent) patients, respectively. Sterile pyuria were all normalized. But, 36 patients(12.8 percent) showed thrombocytosis, 22(7.8 percent) elevated AST, 15(5.3 percent) leukocytosis, and 6(2.1 percent) coronary abnormalities. Coronary abnormalities at the 6th week were only shown in patients with initial abnormalites. Younger age and initial thrombocytosis were risk factors for thrombocytosis at the 6th week. Conclusion : All children with initial coronary abonormalites should have an echocardiogram at 6 weeks after the onset of fever. In view of case-effectiveness, additional echocardiographic studies are justified only if abnormalities are present at admission. ESR, CRP, and urinalysis performed at the 6 weeks after onset of KD is not significant for clinical information of progression. Platelet count should be estimated at 6th week for a judgement of continuous antiplatelet therapy.

목 적 : 가와사끼병에서 급성기 항염치료 후 회복기에 항혈전 요법으로 저용량 아스피린을 사용한다. 대개 6-8주간 투여하고 종료 시기에 혈소판 치를 포함한 각종 혈액검사와 관상동맥 이상 유무를 알기 위한 심초음파 검사를 시행하기도 한다. 발병 6주째에 시행하는 각종 추적검사가 임상적으로 얼마나 유용한지 알아보고자 본 조사를 시행하였다. 방 법 : 1997년 1월부터 2004년 12월까지 만 8년간 원광대학교병원 소아과에 입원하여 가와사끼병으로 치료받았던 282명의 환자를 대상으로 후향적으로 조사하였다. 입원 당시와 6주째에 백혈구수와 혈소판수, ASO, ESR, CRP, AST, ALT, 소변검사, 심초음파 검사를 시행하였다. 6주째에 혈소판이 증가했던 군과 대조군을 각종 검사 척도로 비교하였고, 나이와 성별, 재치료 여부, 발열-입원 기간, 치료-해열 기간, 관상동맥 이상 등이 6주째의 혈소판 증가에 영향을 미치는지 비교 분석하였다. 통계적 비교는 paired t-test와 Fisher's exact test, logistic 회귀분석으로 하였다. 결 과 : 입원 시에 증가를 보였던 ESR과 CRP는 6주째 시행한 검사상 각각 35명(12.4%), 12명(4.3%)을 제외하고 정상화되었고, 무균성 농뇨는 전례에서 모두 정상화되었다. 혈소판 증가는 36명(12.8%), 백혈구 이상 15명(5.3%), 관상동맥 이상 6명(2.1%), AST 상승 22명(7.8%), ALT 상승 3명(1.1%), AST/ALT 동시 상승은 3명(1.1%)에서 관찰되었다. 관상동맥 이상은 발병 초기에 이상을 보였던 경우에서만 관찰되었다. 6주째의 혈소판 증가군에서 대조군에 비해 성별과 재치료, 입원 시의 백혈구 이상, 농뇨, AST/ALT의 동시상승, 관상동맥 이상 빈도의 비교에서 모두 유의한 차이가 없었다. 6주째의 혈소판 증가에 영향을 주는 인자로는 어린 나이와 발병초기의 혈소판 증가증이었다. 발열-입원 기간과 치료-해열 기간, 입원 시의 ESR, CRP, AST, ALT치는 영향을 주지 않았다. 입원 시와 6주째의 혈소판 증가는 관상동맥 이상에 영향을 주지 않았다. 결 론 : 가와사끼병에서 6주째에 시행하는 각종 추적검사에서 소변 검사는 생략해도 될 것으로 보이며, 심초음파 검사는 발병 초기에 이상이 있었던 군에서만 선택적으로 시행해도 될 가능성을 시사했지만 이에 대한 연구가 더 필요하다고 판단된다. 혈소판 수는 계속적인 항혈전 치료와 관련이 있으므로 6주째의 검사가 필요하나, 백혈구수와 AST, ALT, ESR, CRP 검사의 임상적 의의는 크지 않다고 판단된다.

Keywords

Acknowledgement

Supported by : 원광대학교

References

  1. Brogan PA, Bose A, Burgner D, Shingadia D, Tulloh R, Michie C, et al. Kawasaki disease : an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002;86:286-90 https://doi.org/10.1136/adc.86.4.286
  2. Holman RC, Curns AT, Belay ED, Steiner CA, Schonberger LB. Kawasaki syndrome hospitalizations in the United States, 1997 and 2000. Pediatrics 2003;112:495-501 https://doi.org/10.1542/peds.112.3.495
  3. Chang RK. The incidence of Kawasaki disease in the United States did not increase between 1988 and 1997. Pediatrics 2003;111:1124-7 https://doi.org/10.1542/peds.111.5.1124
  4. Murugan SJ, Thomson J, Parsons JM. Is life long follow up for patients with Kawasaki disease indicated? Arch Dis Child 2003;88:91 https://doi.org/10.1136/adc.88.1.91
  5. Dajani AS, Taubert KA, Takahashi M. Guidelines for long term management of patients with Kawasaki disease : report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1994;89:916-22 https://doi.org/10.1161/01.CIR.89.2.916
  6. Scott JS, Ettedgui JA, Neches WH. Cost-effective use of echocardiography in children with Kawasaki disease. Pediatrics 1999;104:57 https://doi.org/10.1542/peds.104.5.e57
  7. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776-80 https://doi.org/10.1161/01.CIR.87.5.1776
  8. Shulman ST, Inocencio J, Hirsch R. Kawasaki disease. Pediatr Clin North Am 1995;42:1205-22 https://doi.org/10.1016/S0031-3955(16)40059-3
  9. Tizard JE. Recognition and management of Kawasaki disease. Curr Paediatr 1999;8:97-101
  10. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and longterm 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. Pediatrics 2004;114:1708-33 https://doi.org/10.1542/peds.2004-2182
  11. Cassidy JT, Petty RE. Vasculitis. In : Textbook of pediatric rheumatology, 3rd ed. Philadelphia : WB Saunders Company, 2001:365-422
  12. Jang YJ, Kim JK, Yun YS. Clinical studies of the Kawasaki disease. J Korean Pediatr Soc 1992;35:330-40
  13. Park MY, Shim GS, Cha SH, Ahn CI. Clinical studies of the Kawasaki disease. J Korean Pediatr Soc 1994;37:167-76
  14. Lee JW, Lee KY. Alteration of biochemical profiles after high-dose intravenous immunoglobulin administration in Kawasaki disease. J Korean Pediatr Soc 2003;46:17-20
  15. Cho EY, Lee MH, Kang KS, No ES, Lee DJ, Choi MB, et al. Serum C-reative protein as a predictor for cardiac sequelae in Kawasaki disease. J Korean Pediatr Cardiol Soc 2000;6:90-6
  16. Park MY, Lee KI, Han JH, Lee HS, Hong JH, Whang KT. Laboratory values in patients with Kawasaki disease after intravenous immunoglobulin : Comparison of patients with coronary artery lesions to those without coronary artery lesions. Korean J Pediatr 2003;46:162-6
  17. Tuohy AMM, Tani LY, Cetta F. How many echocardiograms are necessary for follow up evaluation of patients with Kawasaki disease? Am J Cardiol 2001;88:328-30 https://doi.org/10.1016/S0002-9149(01)01655-1