283例川崎病的临床分析  

Review and analysis of 283 cases of Kawasaki disease

作　　者：王琍[1] 林毅[2] 苏英姿[1] 汪芸[1] 赵地[1] 吴铁吉[1] 

机构地区：[1]首都儿科研究所内科,北京100020 [2]海南省三亚市人民医院儿科

出　　处：《中华儿科杂志》2004年第8期609-612,共4页Chinese Journal of Pediatrics

摘　　要：目的 总结川崎病住院患儿的临床表现及心血管系统的并发症,为尽早、正确判断川崎病的病情与预后提供临床依据。方法 回顾性研究1992—2002年住院川崎病患儿283例,分析:(1)川崎病各种临床表现的发生率;(2)合并冠状动脉瘤发生的危险因素。结果(1)283例中男186例,女97例;男女比例为1.9:1,年龄分布以婴幼儿为主,3岁以内(包括3岁)占71％;发病季节以春、夏季为主;不典型川崎病55例(19.4％);就诊前平均发热天数6.1 d,除发热外,其他症状出现频率的次序是:口腔黏膜改变(97.5％),淋巴结肿大(95.4％),球结膜充血(91.2％),指、趾端脱皮(89.8％),皮疹(81.5％)。(2)心血管改变情况:治疗前合并冠状动脉(简称冠脉)扩张共103例(36.9％),住院2周后新发生冠脉扩张28例(13.3％);有13例形成动脉瘤(4.7％),在冠状动脉病变人群中占9.9％。分析动脉瘤的形成是与性别、发热持续时间(>8.9 d)有关(P<0.05)。治疗前合并心房、室腔扩大40例(14.3％);心包积液11例(3.9％);合并心电图改变有57例(20.8％)。结论 川崎病心血管并发症出现较早,经治疗后有13.3％新发冠状动脉病变。动脉瘤的形成与性别、发热持续时间有关。Objective The aim of the study was to review the cases of Kawasaki Disease (KD) and analyze the clinical features especially their cardiac complications. Methods Totally 283 patients with KD were hospitalized from 1992 to 2002. Their clinical features and factors associated with increased risk of coronary artery aneurysms were reviewed. Results ( 1) Among the 283 KD patients, 186 were male and 97 were female. The male-female ratio was 1. 9 : 1. Most of them (71%) were younger than 3 years old. Seasonal peak was in spring and summer (from May to Aug). Depending on the criteria of KD, 228 (81% ) were diagnosed as typical KD and 55 ( 19. 4% ) were atypical KD. All patients had fever, lasting for 6. 1 days. The most common clinical features were oral mucosal changes ( 97.5%) and cervical lymphadenopathy (95.4% ) , conjunctivitis (91. 2% ). And changes in the extremities (89. 8% ) and rash (81. 5% ) were also noted. (2) Before the treatment,coronary artery abnormalities were seen in 103/279 (36. 9% ) , which occurred within 4-30 days of fever onset. Two weeks after intravenous gamma globulin (IVIG) treatment, the new cases of coronary artery abnormalities were 28/211 (13. 3% ). The prevalence of coronary artery aneurysms (CAA) with KD was 4. 7%. The risk factors of CAA were male cases (P < 0. 05) and fever lasting longer than 9 days (P < 0. 05). Other cardiac abnormalities in acute phase included left atrial and ventricular enlargement (40/279, 14. 3% ) and changes in EGG (57/274, 20. 8% ). The pericardial effusions were found in 11 cases (3. 9% ). Conclusions Cardiac complications of KD occurred in the early period of KD. The new cases of coronary artery abnormalities were 13. 3% after IVIG treatment. The risk factors of CAA included male cases and fever lasting for longer time.

关 键 词：川崎病 小儿 并发症 预后 危险因素 黏膜皮肤淋巴结综合征 心血管疾病 冠状动脉瘤 

分 类 号：R725.4[医药卫生—儿科]