川崎病血管损伤的中西医研究进展

Research Progress of Traditional Chinese Medicine and Western Medicine on Vascular Injury of Kawasaki Disease

川崎病又称皮肤黏膜淋巴结综合征,是一种以全身血管炎为主要病变的急性发热出疹性儿童疾病,主要临床表现为发热,口唇发红、皲裂,双眼球结膜充血,全身多形性皮疹、颈部淋巴结肿大、指趾端硬肿、蜕皮,肛周发红和蜕皮等。本病在全世界范围内均有发病,好发于5岁以下儿童,且发病率有逐年增高的趋势,其中以亚洲发病率最高。最新研究表明,日本的发病率为184.6/10万,韩国为90/10万。中国台湾的发病率为69/10万,北京为40.9~55/10万,上海为16.6/10~36.8/10万。中医和西医对于本病均有不同的见解。中医多认为本病是由于外感温热毒邪,犯于肺卫,蕴于肌腠,侵犯营血所致,治疗以清热解毒、活血化瘀为主。西医认为本病可能与感染有关,治疗多采用丙种球蛋白抗感染、阿司匹林抗凝及对症治疗等方法。川崎病血管损伤以全身中、小动脉为主,好发于冠状动脉,造成冠状动脉扩张、狭窄、栓塞,甚至形成动脉瘤,引起血栓形成、冠状动脉阻塞性扩张等,严重者可出现心肌缺血、心肌梗死,甚至导致猝死,严重威胁儿童的生命健康,因此充分认识川崎病血管损伤十分必要。中西医在对川崎病血管损伤的认识上均取得了不同程度的进展,在治疗上取得了不错的疗效。分别从中医、西医对川崎病血管损伤发病机制及治疗的不同认识进行论述。

Kawasaki disease,also known as mucocutaneous lymph node syndrome,is an acute febrile and exanthematous disease in children with systemic vasculitis as its main pathological changes.Its main clinical manifestations are fever,red lips,chapped lips,hyperemia of the conjunctiva of both eyes,systemic pleomorphic skin rash,cervical lymphadenopathy,scleredema of toe end,molting,perianal redness and molting.The disease occurs all over the world,mostly in children under5 years old,and the incidence is increasing year by year,especially in Asia.The latest research shows that the incidence is184.6/100,000 in Japan and 90/100,000 in South Korea.In China,the incidence rate is 69/100,000 in Taiwan,40.9/100,000-55/100,000 in Beijing and 16.6/100,000-36.8/100,000 in Shanghai.Traditional Chinese medicine and Western medicine have different views on this disease.In traditional Chinese medicine,it is believed that the disease is caused by pathogenic heat and toxin caused by external evils invading the lung and muscle striae and then invading the blood circulation.Western medicine thinks that the disease may be related to infection and the treatment is gammaglobulin for anti-infection,aspirin for anti-coagulation and symptomatic treatment methods.Kawasaki disease is characterized by vascular injury of the middle and small arteries in the whole body,which often occurs in the coronary arteries,causing coronary artery dilation,stenosis,embolism and even aneurysm,causing thrombosis and coronary artery occlusion.In severe cases,ischemia myocardial,myocardial infarction and even sudden death may occur,which threaten the life and health of children.Both traditional Chinese medicine and Western medicine have made progress in understanding vascular injury of Kawasaki disease,and have achieved good curative effect in treatment.This article discussed the different understanding of the pathogenesis and treatment of vascular injury in Kawasaki disease from traditional Chinese medicine and Western medicine.