46例川崎病临床分析

Clinical analysis of 46 cases of Kawasaki disease

目的探讨川崎病(Kawasaki disease,KD)的临床特征、并发症、冠脉损害的危险因素及治疗方法。方法对本院2006—2015年住院诊治的46例KD患儿的临床资料进行回顾性统计分析和总结。结果 46例KD患儿均有发热,呈稽留高热或弛张热,热程5~12 d;眼结膜充血、颈部淋巴结肿大、皮疹、口唇潮红皲裂及激惹、烦躁不安症状发生率均较高,超过80%;并发症以呼吸道感染最多,消化道及一过性脓尿较多。心脏彩超检查异常28例,其中心脏扩大2例,二三尖瓣轻度返流12例,心包积液6例,冠脉扩张有22例,部分患者多种心脏损害并存;根据冠脉有无损害分为两组,急性期WBC、PLT明显升高与冠脉损害有显著相关性(P<0.05)。结论早期典型症状表现不充分时,小儿的精神状态以烦躁易激惹提示KD的可能;急性期WBC、PLT明显升高提示出现冠脉扩张的可能性较大。另外对于KD,在关注冠脉损害的同时也需要注意其心肌、心内膜及心包的损害。

Objective To discuss the clinical features, complications and the risk factors of coronary artery lesions and treatment method of Kawasaki disease （KD）. Methods The clinical data of 46 cases of KD children patients hospitalized from 2006 to 2015 were analyzed by retrospective statistics. Results All the 46 patients experienced continued or remittent fever, and lasting from 5 to 12 days. The incidence of other symptoms including eye conjunctival congestion, cervical lymph node swelling, rash, oral cracked and irritability, and restlessness were high and accounted for more than 80%. Respiratory infection was the most common complication, and complication of digestive tract and the transient pyuria were also common. The abnm^nalities of echocardiography were found in 28 cases, including 2 cases of cardiac dilatation, 12 cases of mild mitral and tricuspid regurgitation,6 cases of pericardial effusion,22 cases of coronary artery dilation, mutiple abnormalities coexisted in some patients. All patients were divided into two groups according to coronary artery lesion with and without damage, greatly increase of WBC and PLT in acute phase of KD showed a significant correlation with coronary artery damage （P〈0.05）. Conclusion Patients＂ mental states, such as irritability and abnormal erying, suggest the possibility of KD when typical symptoms were not obvious with the onset of the disease. A significant increase in WBC and PLT in acute phase indicates a higer risk of coronary dilatation. For KD patients, more attention should be paid to myocardial, endocardium and cardiac damage as well to coronary artery damage.