川崎病合并冠状动脉病变诊治分析

Analysis of diagnosis and treatment for Kawasaki Disease combined with coronary artery disease

目的分析川崎病(KD)的临床特征,指导早期诊断、合理治疗,减少冠状动脉病变(CAL)的发生。方法回顾性分析2016年1月至2018年12月694例KD患儿临床资料,总结其临床特征、KD合并CAL的高危因素、静脉用丙种球蛋白(IVIG)应用时间对IVIG抵抗及CAL发生的影响。结果KD患儿年龄分布为1个月~11岁,<6岁患儿占96.2%;男∶女=1.49∶1;6种主要临床表现中,发热最常见,指端脱皮发生率最低,不完全川崎(iKD)与完全川崎(cKD)比较皮疹、球结膜充血、淋巴结肿大、口腔黏膜改变及肢端肿胀脱皮发生率均明显低于cKD组,差异均有统计学意义(P<0.05)。实验室化验指标中中性粒细胞比例(N%)、血红蛋白(Hb)、血沉(ESR)与KD合并CAL的发生独立相关,为CAL发生的独立危险因素。IVIG无反应型KD发生率为2.45%,发热5 d内给予IVIG,产生IVIG抵抗的发生率较6~10 d及>10 d以上应用组明显升高(P<0.01)。发热5 d内与6~10 d给予IVIG组CAL发生率差异无统计学意义(P>0.05),2组CAL发生率与>10 d应用组比较明显降低,差异有统计学意义(P<0.01)。结论KD发病性别无明显差异,主要临床表现中,发热最常见,指端脱皮发生率最低,iKD组较cKD组表现除发热外,其他主要表现均明显少于cKD组。化验检查中Hb减低、N%及ESR升高可作为CAL的独立危险因素。5 d内应用IVIG发生抵抗率增高,且不能降低CAL发生,5~10 d应用IVIG CAL发生率最低。

Objective To analyze the clinical characteristics of Kawasaki Disease(KD)in order to guide the early diagnosis and reasonable treatment,and reduce the incidence rate of coronary arterial lesions(CAL).Methods The clinical data about 694 child patients with Kawasaki Disease were retrospectively analyzed.The clinical features,the high risk factor of KD combined with CAL,and the effects of intravenous immunoglobulin(IVIG)application time on the resistance of IVIG and the incidence of CAL were analyzed.Results The age distribution of patients with was 1 month to 11 years,of whom,the patients with age<6 accounted for 96.2%,with the ratio of male vs female being 1.49∶1.The fever was the most common symptom,and the incidence of finger tip peeling was the lowest.The incidence rates of rash,bulbar conjunctival congestion,swollen lymph nodes,the changes in oral mucosa,swelling and exfoliation of acra in iKD group were significantly lower than those cKD group(P<0.05).Moreover the ratio of of neutrophils(N%),hemoglobin(Hb)and erythrocyte sedimentation rate(ESR)were the independent risk factors of incidence of CAL.The incidence rate of no-reaction IVIG was 2.45%.The incidence rate of IVIG resistance in patients who were treated by IVIG within 5 days after fever was significantly higher than that of patients receiving IVIG treatment from 6 to 10 days and over 10 days(P<0.01).In addition,the incidence rates within 5 days after in both groups were significantly decreased(P<0.01).Conclusion There is no significant difference in the gender of KD mobidity.The fever is the most common symptom,and the incidence of finger tip peeling is the lowest.The decrease of Hb,and the increase of N%and ESR can be regarded as the independent risk factors of CAL.The IVIG administration within 5 days can increase the incidence of IVIG resistance and the incidence rate of IVIG CAL is the lowest in medication of IVIG during 5~10 days.