24例儿童川崎病的早期诊断及冠状动脉扩张高危因素分析

Study on early diagnosis and high-risk factors of coronary artery ectasia of Kawasaki disease

目的:探讨川崎病(KD)的早期诊断线索及冠状动脉损害的高危因素。方法:回顾性分析2 4例KD患儿的年龄、性别、临床表现、血常规及白细胞分类、血小板计数(PLT)、血沉(ESR)、C -反应蛋白(CRP)及心脏彩超测量冠状动脉内径。结果:KD发病以3岁以下的男性患儿居多,发热、唇及口腔黏膜改变、皮疹、球结膜充血(非化脓性)、手足硬肿和颈淋巴结肿大的发生率高达10 0 %、88%、83%、79%、2 1%、2 5 %。白细胞总数、中性粒细胞分类升高,血沉增快,CRP升高,血小板计数,分别占87 5 %、83 3%、82 6 %、75 %和83 3%。结论:发热患儿早期出现唇充血皲裂及口腔黏膜充血、皮疹、球结膜充血(无分泌物) ,同时伴有白细胞总数、中性粒细胞分类升高,血沉增快和CRP升高要高度怀疑KD的诊断,及早进行心脏超声检查了解有无冠状动脉扩张,以确定KD的诊断。3岁以下的男孩,ESR、CRP、PLT计数明显升高是冠状动脉扩张(CAD)的高危因素。

Aim: Discussing early diagnosis and high-risk factors of coronary artery lesions of Kawasaki disease.Methods: Retrospective review of 24 children with Kawasaki's disease, information included age, sex, clinical manifestations, development of cardiovascular abnormalities, and incidence rate.Results: Most of the cases occurred before the age of 3 years. The most common clinical features were fever (100%), oral mucosal changes (88%) and rash (83%). The next common features were conjunctivitis (79%), changes in the extremities (21%) and cervical lymphadenopathy (25%). Laboratory findings include elevated WBC count with predominance of neutrophils, thrombocytosis, elevated erythrocyte sedimentation rate, positive C-reactive protein test result.Conclusion: Factors associated with an increased risk of coronary artery ectasia include male sex, age less than 3 year and elevated erythrocyte sedimentation rate, positive C-reactive protein test result.