川崎病合并重症感染患儿的预后分析

Analysis on the children with Kawasaki disease combined with severe infection

目的:探讨重症感染与川崎病(KD)预后的关系。方法:选自2005年5月～2010年5月于该院儿科诊治的、发热7天以内的KD患儿,共271例,均符合第3届国际川崎病会议修订的诊断标准。将271例KD患儿分为重症感染组和非重症感染组〔参照小儿危重症评分法(草案)〕。重症感染组73例,包括重症肺炎44例(其中17例患儿血清肺炎支原体IgM滴度≥1∶160),病毒性脑炎20例,败血症9例。非重症感染组198例。结果:重症感染组年龄<1岁的人数与非重症感染组间差别有统计学意义(P<0.05),但两组之间性别为男性的差别无统计学意义(P>0.05);重症感染组血小板<350×109/L、血沉>60 mm/h,C-反应蛋白>45 mg/L人数明显高于非重症感染组(P<0.05);而红细胞压积<0.35、血清清蛋白<35 g/L两组比较差异无统计学意义(P>0.05)。应用丙种球蛋白(IVIG)治疗36 h后,重症感染组热退例数少于非重症感染组(χ2=13.155,P<0.05);1个月内存在冠状动脉(冠脉)扩张者两组间差异无统计学意义(χ2=2.450,P>0.05);6个月后残留冠脉扩张者,重症感染组高于非重症感染组(χ2=4.595,P<0.05)。结论:①重症感染患儿其冠脉病变危险因素的几率较高,提示重症感染可作为KD预后不良的早期指标之一。②KD合并重症感染患儿对IVIG治疗反应较差,并易发生冠脉扩张。因此,对KD合并重症感染患儿应提高认识,及早治疗,警惕其发生冠脉病变。

Objective： To explore the relationship between severe infection and prognosis of Kawasaki disease. Methods： A total of 271 children with Kawasaki disease who were diagnosed and treated in pediatric department of the hospital and got fever within seven days from May 2005 to May 2010 were selected, and all the children conformed to the diagnostic criteria revised on the Third International Ka- wasaki Disease Symposium. All the children were divided into severe infection group （73 children） and non -severe infection group （198 children） according to the score of children with critical illness （preliminary draft） . Forty -four children with severe pneumonia （including 17 children with serum Mycoplasma pneumoniae IgM titer≥1： 160）, 20 children with viral encephalitis, and 9 children with sepsis were included into severe infection group. Results ： There was significant difference in the number of children under one year old between severe infection group and non -severe infection group （P 〈 0. 05 ）, but there was no significant difference in the number of boys between the two groups （ P 〉 0.05 ） . The numbers of children with platelet 〈 350 x 109/L, erythroeyte sedimentation rate 〉 60 ram/h, and C - reactive protein 〉 45 mg/L in severe infection group were significantly higher than those in non -severe infection group （P 〈 0. 05 ） ; there was no significant difference in the numbers of children with hematoerit 〈 0. 35 and serum albumin 〈 35 g/L between the two groups （P 〉 0. 05 ） . After treating the children with gamma globulin for 36 hours, the number of children with pyretolysis in severe infection group was less than that in non - severe infection group （χ2 = 13. 155, P 〈 0. 05 ） . There was no significant difference in the number of children with coronary arterieetasis within one month between the two groups （χ2 = 2. 450, P 〉 0. 05 ） ; the number of children with coronary arteriectasis within six months in severe infection group was significantly higher than that in non - severe infection group （χ2 = 4. 595, P 〈 0. 05 ） . Conclusion： The chil- dren with severe infection have high probability of coronary artery lesions, which indicates that severe infection can be used as an early indicator of poor prognosis of Kawasaki disease. The reaction of children with Kawasaki disease combined with severe infection to gamma globulin therapy is poor, and the children are prone to combine with coronary arteriectasis. Thus, the children with Kawasaki disease combined with severe infection should be diagnosed and treated early, more attention should be paid to coronary artery lesions.