川崎病85例

Clinical Research of Kawasaki Disease in Children

目的探讨川崎病（KD）患儿临床表现及并冠状动脉损害（CAL）的危险因素。方法对85例KD患儿进行临床分析。分析其年龄、性别、临床表现及心血管并发症的发生率，辅助检查等异常情况。对无CAL31例和并CAL54例患儿病程、实验室检查结果进行比较，分析CAL及冠脉瘤（CAA）发生的危险因素及治疗。结果1．男56例，女29例；年龄26个月～5岁者77例（90％）。KD并CAL发生率与WBC计数、血小板、血沉增高及血红蛋白、血清钠降低密切相关（P〈0．05）；与年龄、性别、发热天数均无相关性（P〉0．05）。除发热外，口唇潮红者占95％，皮疹占82％，球结膜充血占80％，颈部淋巴结大占75％，指趾端脱皮占70．5％，口唇及口腔改变占68％。2．心血管改变情况：并CAL54例（63．5％），3例形成CAA，在冠状动脉病变人群中占5．5％，占KD3．5％。左房左室扩大30例（35％），心包积液6例（7％），有心电图改变23例（27％）。病程5d以上确诊KD的患儿静脉注射人血丙种球蛋白（IVIG）和口服阿司匹林疗效均显著。结论5岁以下KD男童发病率高，早期大剂量应用IVIG对防治CAL有重要作用。

Objective To explore the clinical features of Kawasaki disease（KD） in children and risk factors of coronary artery lesions （CAL）. Methods Eighty five children who presented in our hospital from January 2000 to October 2005 were diagnosed as KD, their age and sex distribution, clinical features, incidence of coronary artery disease and initial laboratory findings were analyzed. The patients were divided into two groups： CAL group and non- CAL group. The histories and findings of laboratory tests was compared,and risk factors of CAL and coronary artery aneurysm （CAA） were analyzed, and treatments of KD was investigated. Results 1. In 85 KD children, there were 56 males and 29 females. The ratio of male to female was 1.9 ： 1.0. Seventy-seven children were younger than 5 years old, took 90 % of 85 patients. Incidence of CAL was related to increased level of WBC, PLT, ESR and decreased level of lab and serum sodium （ P 〈 0.05 ） . There was no significant difference in age, days of fever between two groups（ P 〉 0.05）. Besides fever, syrnptoms in all cases were red lips （95 % ）, rush （82 % ）, conjunctival injection （80 % ）, enlarged cervical lymph node （75 % ）, induration and erythema of hands and feet （70.5 % ）, changes in lips and oral cavity （68 % ）. 2. In 54 CAL patients, 3 cases were CAA （5.5 % ）, took 3.5 % in all those KD children; 30 cases were enlargement of left atrium or left ventricle （35 % ）; 6 cases were hydropericardium （7%）; 23 cases were EKG changes （27 % ）. Conclusions KD affects children predominantly less than 5 years old. Treatment of intravenous immunoglobulin in the early stage is useful to prevent CAL in KD.