川崎病合并感染时临床特征及淋巴细胞亚群、免疫球蛋白水平变化

Clinical characteristics and changes in lymphocyte subsets and immunoglobulin level in children with Kawasaki disease complicated with infection

目的探讨川崎病合并感染时的临床特征及淋巴细胞亚群、Ig水平的变化。方法收集29例合并感染的川崎病患儿为感染组,同期未合并感染的35例川崎病患儿为非感染组,21例腹股沟疝患儿为对照组。比较感染组与非感染组患儿临床特征、实验室结果、丙种球蛋白治疗效果及冠状动脉损伤情况,比较3组患儿外周淋巴细胞亚群及血清Ig水平。结果感染组与非感染组的临床特征、实验室指标、丙种球蛋白治疗效果及近期冠状动脉损伤比较差异均无统计学意义(P均>0.05),感染组远期冠状动脉损伤率高于非感染组(P<0.05)。与对照组相比,2组川崎病患儿CD4+、CD4+/CD8+、CD19+T细胞比例较高且Ig G、Ig A、Ig M水平升高(P均<0.05),CD8+T细胞水平下降(P<0.05)。感染组与非感染组间外周淋巴细胞亚群及血清免疫球蛋白水平比较差异无统计学意义(P均>0.05)。结论感染并未影响川崎病患儿的临床特征、实验室结果、丙种球蛋白治疗反应及近期冠状动脉损伤发生率,可能与感染并未进一步影响机体免疫水平有关,但合并感染可能增加远期冠状动脉损伤的风险,需注意随访。

Objective To investigate the clinical characteristics and changes in the lymphocyte sub-sets and immunoglobulin levels in children with Kawasaki disease complicated with infection.Methods Twen-ty nine Kawasaki disease children complicated with infection were enrolled in the infection group,thirty five Kawasaki disease children with no infection were recruited in the non-infection group,and twenty one children with inguinal hernia were included in the control group.The clinical characteristics,laboratory data,therapeu-tic effect of gamma globulin and short-term coronary artery lesion were statistically compared between the infec-tion and non-infection groups.The lymphocyte subsets and immunoglobulin levels were statistically compared a-mong all three groups.Results The clinical characteristics,laboratory data,therapeutic effect and short-term coronary artery lesion did not significantly differ between the infection and non-infection groups （all P 〉0.05）, whereas the incidence of long-term coronary artery lesion in the infection group was considerably higher com-pared with that in the non-infection group （P 〈0.05）Compared with the control group,the levels of CD4 ＋, CD4 ＋/CD8 ＋ and CD19 ＋ were significantly higher,IgG,IgA and IgMwere significantly elevated,whereas the level of CD8 ＋ was dramatically decreased in children with Kawasaki disease （all P 〈0.05）.The lymphocyte subsets and immunoglobulin levels did not significantly differ between the infection and non-infection groups （both P 〉0.05）.Conclusions Infection did not affect the clinical characteristics,laboratory data,therapeu-tic effect or short-term coronary artery lesion in children diagnosed with Kawasaki disease,probably because the infection did not influence the host immunity.However,the infection possibly increased the risk of coronary ar-tery lesion in the long term and such patients should be closely followed up.