小儿川崎病36例临床治疗分析

Clinical Analysis of 36 Children With Kawasaki Disease

目的探讨川崎病(KD)患儿的临床表现、诊断及治疗方案。方法选择2007年9月至2010年6月本院收治并诊断为KD,且常规接受口服阿司匹林治疗的36例患儿的临床病历资料为研究对象。其年龄为2个月～6岁。采用回顾性分析法,对KD患儿临床病历资料中的临床症状及治疗方案进行相关分析。按照静脉输注丙种球蛋白(intravenous immunoglobulin,IVIG)治疗剂量不同,将36例KD患儿分为A组[n=8,0.4g/(kg·d)×3d],B组[n=20,1g/(kg·d)×2d]和C组[n=8,2g/(kg·d)×1d]。3组患儿的KD初诊年龄、病情严重程度及相关并发症发生情况等比较,差异无统计学意义(P>0.05)(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,征得患儿监护人的知情同意,并签署知情同意书)。结果本组KD患儿最常见的临床表现为发热,口腔黏膜及咽部弥漫性充血,口、唇潮红及皲裂等,并且均为KD最早期症状;实验室检查表现为C反应蛋白(CRP)异常升高、白细胞计数升高及血沉增快等早期表现。不同IVIG剂量组的退热时间比较,B组、C组分别与A组比较,差异有统计学意义(P<0.05);但B组与C组比较,差异无统计学意义(P>0.05)。结论 KD的治疗重点为极早控制血管炎,防止形成冠状动脉瘤(CAA)等。对诊断为KD患儿采用IVIG[(1～2)g/(kg·d)×(1～2)d]治疗,具有更强退热效果。

Objective To analyze clinical manifestations, diagnosis and treatment measures of 36 children with Kawasaki disease （KD）. Methods From September 2007 to June 2010, a total of 36 children with KD, at the age from 2-month-old to six-year-old, were admitted to our hospital. We retrospectively reviewed the clinical data of the 36 children with KD, summarized data of clinical manifestations and treatment measures. They were divided into three groups according to different dose of intravenous immunoglobulin （IVIG）, group A In：8, 0.4 g/（kg · d）× 3 d], group B l-n=20, 1 g/（kg · d）×2 d] and group C In--8, 2 g/（kg· d）×1 d]. There had no significant difference among three groups on ages, severity of the diseases, and related complications （P〉0.05）. 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. Results Fever, hyperaemia of oral and pharynx mucosal, and chap of lips mucosal were the most common signs of KID children. Abnormal rise of C-reactive protein （CRP） level, white cell count and erythrocyte sedimentation rate （ESR） were the most common abnormalities of laboratory test in the early course. There were significant differences between group A and group B, group A and group C （P〈0.05）, but there had no significant difference between group B and group C （P〉0.05）. Conclusions Early control of vasculitis are very important to KD, in order to prevent the formation of coronary artery aneurysms （CAA）. The IVIG dose at （1 -2）g/（kg ·d） has more powerful antifebrile efficacy.