儿童典型和不典型川崎病72例临床及冠脉损害分析

An analysis on clinical manifestations of 72 pediatric patients with typical or atypical Kawasaki disease and clinical coronary artery lesions

目的对儿童川崎病(KD)的临床特点以及冠脉损害(CAL)的高危因素进行分析,为临床诊治提供依据。方法回顾性分析2013年10月至2015年9月收治的KD患儿72例,按照临床表现的不同分为典型组和不典型组,比较两组患儿的临床特征,记录两组患儿的实验室检验指标并对CAL的高危因素进行探讨。结果 56例为典型KD患儿,其中合并CAL的患儿8例,CAL发生率14.29%;16例为非典型KD患儿,其中合并CAL的患儿7例,CAL发生率43.75%;非典型KD患儿CAL发生率明显高于典型SD患儿(P<0.05);典型KD患儿的临床表现如草莓舌、淋巴结肿大、口唇皲裂和肛周脱屑等的发生率明显高于非典型KD患儿(P<0.05);此外,合并CAL患儿的实验室指标如白细胞、C反应蛋白、红细胞沉降率等均明显高于不合并CAL患儿(P<0.05)。结论不典型KD的CAL发生率较高,临床表现不显著且好发于<1岁的儿童,而白细胞、C反应蛋白、红细胞沉降率等明显升高可能是川崎病患儿发生CAL的危险因素。

Objective To analyze the clinical characteristics of pediatric patients with Kawasaki disease（KD）as well as the risk factors for coronary artery lesions（CAL）in order to provide the basis for its clinical diagnosis and treatment. Methods The clinical data of 72 pedatric patients with KD during October 2013 to September 2015 in this hospital were retrospectively analyzed,and they were divided into typical and a-typical groups according to their clinical manifestations and characteristics in these two groups of children,and their risk factors for coronary artery lesions were discussed. Results Among fifty six patients with typical KD,8 cases merged with CAL,and its incidence was14. 29% . Among 16 pediatric patients with atypical KD,7 cases were complicated with CA,hence the incidence of CAL was 43. 76% ,and their difference was statisti-cally significant（ P 〈 0. 05）. The typical clinical manifestations of KD in children were strawberry tongue,swollen lymph nodes,chapped lips and perianal desquamation,and they were higher in pediatric patients with atypical KD（ P 〈 0. 05）. In addition,the laboratory parameters such as white blood cells count,level of C - reactive protein,erythrocyte sedimentation rate etc in KD patients complicated with CAL were higher than those of pateints without CAL. Conclusion The incidence of coronary artery lesions in patients with atypical KD is higher,and their clinical man-ifestations are not significant and usually occur in children 〈 1 year of age. and the white blood cells count,serum level of C - reactive protein and erythrocyte sedimentation rate were significantly higher in pediatric patients with atypical Kawasaki disease,and they are the risk factors for suffere-ing of coronary artery lesions.