儿童川崎病115例临床分析

Clinical Analysis of Kawasaki Disease in 115 Children

目的:探讨儿童川崎病(KD)的临床特征、实验室检查、冠状动脉病变(CAL)的相关危险因素及治疗方法。方法:对2003年1月至2013年6月入住我院的115例KD患儿的临床资料进行回顾性分析。结果:(1)男73例(63.5%),女42例(36.5%),5岁以内96例(83.5%)。(2)典型KD 90例,不完全性KD(IKD)25例;IKD组婴儿(<1岁)比例和CAL发生率均高于典型KD组(44.0%vs 7.8%,40.0%vs 17.8%,P均<0.05);除肛周脱屑、卡疤红肿外,IKD组其他临床症状发生率低于典型KD组,出现时间晚于KD组(P均<0.05);除血红蛋白外,两组实验室检查指标比较差异无统计学意义(P>0.05)。(3)CAL组男性比例、婴儿比例、发热时间、血小板计数(PLT)、血红胞沉降率(ESR)、C反应蛋白(CRP)水平均大(高)于非CAL组(P均<0.05)。(4)KD发病10 d内的CAL发生率低于发病10 d后,且治疗2周后复查发病10 d内给予静脉用免疫球蛋白组新CAL发生率低于发病10 d后给予IVIG组(P<0.05)。结论:IKD多发于婴儿,且其CAL发生率较高,肛周脱屑、卡疤红肿有助于其早期诊断;CAL发生率与男性、年龄<1岁、发热时间、PLT、ESR、CRP有关;KD发病10 d内应用静脉用免疫球蛋白效果较好。

Objective： To investigate the clinical features, laboratory examination, risk factors of coronary artery lesions （CAL） and treatment for Kawasaki disease （KD） in children. Methods： The clinical data of 115 KD children who hospitalized in our hospital from January 2003 to June 2013 were retrospectively analyzed. Results： （1） In our study, 73 cases were male and 42 cases were female. 83.5% （96/115） of our cases were less than 5 years old. （2） Ninety cases were diagnosed as typical KD and 25 cases were diagnosed as incomplete Kawasaki disease （IKD）. The proportion of infants and the incidence of CAL in the IKD group were higher than that in the typical KD group （P〈0.05）. Except for the incidence of perianal desquamation and redness of the BCG vaccination scar, the incidence of other symptoms and signs in the IKD group were lower than that in the typical KD group （P〈0.05）. Except for Hb, otherlaboratory examinations in the typical KD group were not statistically different from that in the IKD group （ P 〉 0.05 ）. （ 3 ） The proportion of males, the proportion of infants, fever days, PLT, ESR, CRP in the CAL group were higher than that in the non-CAL group （P〈0.05）. （4） Before treatment with IVIG, the incidence of CAL was lower in the group having received IVIG within 10 days to the onset than that in the group having received IVIG 10 days later to the onset （P〈0.05）. Two weeks after treatment with IVIG, the incidence of new CAL was lower in the group having received IVIG within 10 days to the onset than that in the group having received IVIG 10 days later to the onset （ P〈0.05 ）. Conclusion： （ 1 ） IKD was more common in infants and performed higher incidence of CAL. Perianal desquamation and redness of the BCG vaccination scar were helpful to early diagnose to IKD. （2） The incidence of CAL was associated with male, infant, fever days, PLT, ESR and C RP. （3） The children who received IVIG treatment within 10 days to the KD onset had less chance of developing new CAL.