Analysis of Kawasaki disease complicated with atlantoaxial rotatory subluxation / 中华实用儿科临床杂志

ABSTRACT

Objective:To investigate the clinical characteristics of children with Kawasaki disease (KD) complicated with atlantoaxial rotatory subluxation (AARS).Methods:Clinical characteristics of 60 AARS patients complicated with KD (the atlantoaxial rotatory subluxation group) and 60 patients with KD only diagnosed (the control group)in the Children′s Hospital of Chongqing Medical University from December 2010 to December 2019 were retrospectively analyzed.Differences between groups were compared by the Chi- square test and the t test. Results:A total of 8 365 KD patients were diagnosed during the study period, involving 60 cases (0.72%) complicated with AARS.which usually occurred in the acute phase with the onset ages of 3 to 6 years ( P<0.001). Initial clinical symptoms of KD complicated with AARS included fever with restricted neck movement (100.00%), neck mass (66.67%), torticollis (21.67%) and neck pain (11.67%). CT or X-ray exa-mination of the neck indicated AARS, with thickening and swelling of the cervical soft tissues in some cases.Compared with those of control group, red, dry, cracked lips ( P=0.01) and cervical lymph node swollen ( P<0.001) were significantly pronounced in KD patients complicated with AARS.The absolute and relative count of neutrophils were significantly higher in KD patients complicated with AARS (all P< 0.05). Cervical soft tissue swelling and thickening in B-ultrasound were more obvious than those in the control group( P<0.05). However, there were no significant differences in coronary artery lesions and the response to intravenous immunoglobulin (IVIG) combined with Aspirin between groups ( P>0.05). Head traction could relieve neck symptoms to a certain extent, but there was no significant difference between groups ( P>0.05). Conclusions:Cervical lymphadenopathy, red, dry, cracked lips, increase of absolute and relative count of neutrophils, and swelling and thicke-ning of cervical soft tissues were the high-risk factors of KD complicated with AARS.The complication of AARS in KD patients did not increase the risk of coronary artery injury and IVIG resistance.IVIG combined with aspirin achieved a good prognosis in the majority of KD patients complicated with AARS.