川崎病合并无菌性高白细胞尿相关研究

Analysis of sterile pyuria in patients with Kawasaki disease

目的分析川崎病(KD)合并无菌性高白细胞尿的临床特征及相关发病机制。方法选取住院治疗的420例KD患儿作为研究对象,根据入院尿常规检查将其分为高白细胞尿组(95例)和对照组(325例),对比分析两组的临床资料。结果两组患儿的性别、年龄及不典型KD发生比例的差异均无统计学意义(P均>0.05)。高白细胞尿组的C反应蛋白、D-二聚体、纤维蛋白原降解产物、谷丙转氨酶、谷草转氨酶、尿视黄醇结合蛋白等均高于对照组,差异均有统计学意义(P均<0.05)。两组患儿在入院前平均热程的差异无统计学意义(P?>0.05),但高白细胞尿组入院行丙种球蛋白治疗后发热持续时间更久,差异有统计学意义(P<0.05)。两组患儿在冠状动脉扩张及丙种球蛋白首剂治疗无反应方面的差异也无统计学意义(P>0.05)。结论 KD患儿无菌性高白细胞尿的发病率约为22.6%,伴有高白细胞尿患儿具有更强烈的炎症反应,存在更明显的高凝状态,可能有轻微或亚临床肾损害。

Objectives To explore the clinical features and pathogenesis of Kawasaki disease （KD） combined with sterile pyuria. Methods A total of 420 patients diagnosed of KD were recruited and divided into pyuria group （ 95 patients） and control group （ 325 patients） according to urine routine examination on admission. The clinical data between the two groups were compared. Results There was no difference in gender, age, and the incidence of atypical KD （P all〉0 . 05 ）. The levels of C-reactive protein, D-dimer concentrations, fibrinogen degradation products, alanine aminotransferase, aspartate aminotransferase, and urine retinol binding protein were higher in pyuria group than those in control group （all P〉0 . 05 ）. No difference was found in the duration of fever before admission between two groups （P〉0 . 05 ）. However, pyuria group had longer duration of fever after treatment with immunoglobulin （P〈0 . 05 ）. There was no difference in coronary artery lesions and non-response in the ifrst dose of immunoglobulin treatment between two groups （all P〉0.05）. Conclusion The morbidity of sterile pyuria in KD patients was 22 . 6%. KD patients with sterile pyuria have more intense inlfammatory response, markedly high coagulation condition, and mild or subclinical renal damage.