细菌感染对川崎病预后的影响

Effects of Bacterial Infection on Prognosis of Kawasaki Disease

目的:探讨合并细菌感染川崎病(KD)患儿的临床诊治及转归情况。方法:选取2015年12月至2018年6月住院治疗的川崎病患儿为研究对象,KD患儿共299例符合纳入标准,按照入院后是否合并细菌感染分为无感染组(150例)及感染组(149例),统计分析两组患儿临床资料,包括年龄、性别、热程、冠状动脉瘤、血液及生化指标等。结果:两组患儿年龄差异有统计学意义(t=3.106,P<0.05),两组患儿性别比较差异无统计学意义(P>0.05);两组患儿静脉注射人免疫球蛋白(IVIG)使用前热程比较差异无统计学意义(P>0.05),平均住院时间比较差异有统计学意义(t=2.049,P<0.05);两组患儿不完全川崎病百分比、冠状动脉瘤百分比差异无统计学意义(P>0.05)。两组患儿IVIG无反应性川崎病发生率比较差异有统计学意义(χ^2=7.153,P<0.05);两组患儿实验室指标比较,感染组患儿白细胞计数明显较高(t=2.663,P<0.05)、C反应蛋白(CRP)水平升高(t=2.059,P<0.05)、无菌性脓尿比例升高(χ^2=33.173,P<0.05),两组间血红蛋白、血小板计数、丙氨酸氨基转移酶、N末端前体脑钠肽水平比较差异无统计学意义(P>0.05)。结论:KD患儿中存在部分合并细菌感染灶,婴幼儿较多见,细菌感染可能与IVIG无反应性川崎病发生率相关,但对KD患儿冠状动脉瘤发生率无明显影响。对于这部分患儿,在大剂量IVIG治疗同时,亦应早期给予足疗程抗生素治疗。

Objective:To probe into the clinical diagnose,treatment,and prognosis of children with Kawasaki disease(KD)complicated with bacteria.Methods:Totally 299 children with KD admitted into Dec.2015 to Jun.2018 were extracted as the research objectives.According to whether there was bacterial infection after admission,the patients were divided into the non-infection group(n=150)and infection group(n=149).The clinical data of two groups were statistically analyzed,including age,gender,duration of fever,coronary aneurysm,blood and biochemical indicators.Results:There was statistically significant difference in age between two groups(t=3.106,P<0.05).There was no statistically significant difference in gender between two groups(P>0.05).There was no statistically significant difference in duration of fever before intravenous immunoglobulin(IVIG)administration between two groups(P>0.05),and the difference in average length of stay was statistically significant(t=2.049,P<0.05).The percentage of incomplete KD and percentage of coronary aneurysms in two groups showed no significant difference(P>0.05).There was a statistically significant difference in the incidence of refractory KD between two groups(χ^2=7.153,P<0.05).White blood cell count(t=2.663,P<0.05),C-reactive protein(CRP)levels(t=2.059,P<0.05)and proportion of aseptic purulence(χ^2=33.173,P<0.05)increased significantly in the infection group.There were no statistically significant differences in hemoglobin,CRP,platelet count,alanine aminotransferase and N-terminal precursor brain natriuretic peptide levels between two groups(P>0.05).Conclusion:There are some cases of bacterial infection in children with KD,which are more common in infants.Bacterial infection may be related to the incidence of IVIG unresponsive KD,but it has no significant effect on the incidence of coronary aneurysms in children with KD.For these children,a full course of antibiotics should be given at an early stage during the treatment of large dose of IVIG.