上海地区1998-2002年川崎病流行病学特征

Epidemiologic Pictures of Kawasaki Disease in Shanghai from 1998 through 2002

目的对上海地区川崎病发病情况进行调查,了解中国发达地区川崎病的流行病学特征。方法参照日本流行病学调查方案,制作统一调查表和诊断指南,调查对象为1998年1月1日至2002年12月31日上海地区50家有儿科临床服务的二级及二级以上医院收治的所有川崎病病例。结果调查表回收率100％。将18例不符合诊断标准要求者剔除后,对768例川崎病病例进行分析。上海地区5岁以下儿童川崎病发病率呈逐年增高趋势,1998年为16．79／10万,1999 年为25．65／10万,2000年为28．16／10万,2001年为28．05／10万,2002年为36．76／10万。男女性别比为1.83:1;发病年龄为1个月至18．8岁(中位数1．8岁),发病年龄高峰为9．6个月;全年均可发病,但以春夏之交较多见。主要症状表现为发热持续5 d以上者最为常见(99．3％),其后依次为口唇、口腔黏膜损害(83．5％)、指(趾)端脱皮(82．9％)、皮疹(81．0％)、结膜充血(78．4％)、颈部淋巴结肿大(69．3％)、肢端充血硬肿(48．1％)和肛周脱皮(45．2％)。心血管损害发生率为25． 4％,以冠状动脉扩张最为常见(68％);其次为冠状动脉瘤(10％)。急性期病死率为0．26％,死因为冠状动脉瘤破裂和急性心力衰竭。再发率为1．82％。结论上海地区川崎病发病率明显低于日本,但高于西方国家。发病率呈逐年增高趋势,性别分布和心血管损害与其他报道相似。发病季节分布与北京地区的报道相似,但与其他报道不同。

Objective To investigate the epidemiologic features of Kawasaki disease in the developed area of China. Methods A questionnaire form and diagnostic guidelines for Kawasaki disease were sent to 50 central or tertiary hospitals in Shanghai ,which provided with pediatric medical care. All patients with Kawasaki disease diagnosed during January 1998 through December 2002 were recruited in this study. Results All the 50 hospitals responded to the survey. After 18 cases that did not satisfy the recruited criteria were excluded in the study, a total of 768 patients with Kawasaki disease were reported. The incidence rates of Kawasaki disease for each year were 16.79 （1998） ,25.65 （1999） ,28. 16 （2000） ,28.05 （2001） ,and 36. 76 （2002） per 100 000 children under 5 years of age. The male/female ratio was 1.83： 1. The age at onset ranged from 1 month to 18.8 years （median 1.8 years）. The disease occurred more frequently in spring and summer. Fever was the most common clinical symptom,followed by oral changes, extremities desquamate, rash, conjunctive congestion, lymphadenopathy, extremities swelling, and crissum desquamate. Cardiac abnormalities were found in 25.4% of patients. The most common cardiac abnormality was coronary artery lesions including ectasia （68%） and aneurysm （ 10% ）. Two patients died of heart failure and rupture of coronary aneurysm respectively at acute stage. The case-fatality rate of the disease was 0. 26%. A second onset of the disease occurred in 1.82% of patients. Conclusions The incidence rate of Kawasaki disease in Shanghai is remarkably lower than that reported in Japan,but higher than those in western countries. The increasing trend in incidence, sex distribution and cardiac abnormalities are similar to those in previous reports. The seasonal distribution is similar to the report from Beijing and different from other reports.