261例川崎病合并感染的临床分析

Clinical Analysis of Kawasaki Disease Complicating With Infection: 261 Cases

目的探讨川崎病(KD)合并感染患儿的临床表现、诊断、治疗方案及其预后。方法选择2003年1月至2009年1月在本院确诊的261例KD患儿就诊、治疗和随访的临床病历资料为研究对象。按照KD是否合并感染,将其分为感染组(n=65,24.9%)与非感染组(n=196,75.1%);按照KD是否典型,将其分为典型KD组(n=184,70.5%)与不完全性KD组(n=77,29.5%);再按照是否合并冠状动脉损害(Cals),将其分为合并Cals组(n=24)及未合并Cals组(n=237)。采取回顾性分析方法,分别分析不同年龄KD患儿合并感染的临床表现,比较典型KD组与不完全性KD组及合并Cals组与未合并Cals组的感染临床特征及预后(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准)。感染组与非感染组,典型KD组与不完全性KD组及合并Cals组与未合并Cals组KD患儿的发病年龄中位数、性别及合并其他疾病情况等比较,差异无统计学意义(P>0.05)。结果 261例KD患儿中,不同年龄患儿感染率比较,差异均有统计学意义(P<0.05)。典型KD组与不完全性KD组患儿感染率比较,差异无统计学意义(P>0.05)。合并Cals组与未合并Cals组患儿感染率比较,差异亦无统计学意义(P>0.05)。结论 KD发病时可并存感染,但感染并非与KD预后相关。临床治疗KD时,应注意并发感染情况,同时应全面合理地检查,并合理选用抗菌药物治疗。

Objective To analyze clinical characteristics, diagnosis, treatment methods and prognosis of children with Kawasaki disease （KD） combined with infection. Methods Clinical data, follow-up data and treatment data for 261 KD children who recurited into the Department of Pediatrics, West China Second University Hospital from January 2003 to January 2009 were retrospectively analyzed. According to whether amalgamative infection, they were divided into infection group （n = 65,24. 9%） and non-infection group （n=196,75. 1%）. According to KD types, they were further divided into typical KD group （n= 184, 70.5%） and incomplete KD group （n= 77, 29. 5%）. According to whether coincident coronary artery lesions （Cals）, they were further divided into Cals group （n=24） and no-Cals group （n：237）. This study followed procedures with the committee for human trials of the ethical standards, get the commission for approval, group the consent of the subjects of the guardian informed consent, and its clinical research informed agreement signed. There had no significance difference on gender, median age, and whether combined with other disease between infection group and non-infection group, typical KD group and incomplete KD group, and Cals group and no-Cals group （P〉0.05）. Results Among these 261 cases, incidence rates of KD children with infection had significant difference between different age groups （P〈 0.05）, while prevalence of infection and Cals had no significant difference between typical and incomplete KD group （P〉0.05）. Conclusions Infections are common at the diagnosis of KD but infections do not affect the prognosis. Reasonable examination and antibiotics is useful to cure KD with infection.