川崎病冠状动脉损伤与巨细胞病毒感染因素  

The Impact of Cytomegalovirus Infection on Coronary Artery Lesion with Kawasaki Disease

作　　者：汪霞[1] 杨坤[1] 张丙宏[2] 赵东赤[1] 

机构地区：[1]武汉大学中南医院儿科,湖北武汉430071 [2]武汉大学人民医院儿科,湖北武汉430060

出　　处：《医学新知》2010年第1期16-19,共4页New Medicine

摘　　要：目的分析巨细胞病毒（cytomegalovirus，CMV）感染对川崎病（Kawasaki disease，KD）患儿冠状动脉损伤、治疗反应及预后的影响。方法回顾性分析武汉大学中南医院和武汉大学人民医院2003～2008年确诊为川崎病的105例住院患儿的临床表现、实验室检查结果及冠状动脉损伤（coronary artery lesion，CAL）的资料；免疫荧光法检测外周血清中CMV特异性IgM、IgG。结果105例KD患儿中37．5％（36／96）合并CAL，轻度冠脉扩张30例，冠状动脉瘤6例；65．9％（29／44）的KD患儿血清中CMVIgM呈阳性，其中CAL发生率为52％（13／25），阴性组为30．8％（4／13），差异有显著性（P〈0．01）；冠状动脉受损以双侧为主，其次为左侧，未检出单一右侧冠状动脉异常者。CMV感染患儿较多出现多形性皮疹和手足硬肿，而肛周脱屑较少（P〈0．01）；CMV感染组发生肝损伤5例，阴性组为1例。阳性组对丙种球蛋白治疗不敏感者5例（17．9％），阴性组0例。结论CMV在KD期问具有较高的感染率，与CAL密切相关，对静脉注射丙种球蛋白（IVIG）治疗不敏感。Objective To investigate the impact of coincident cytomegalovirus （CMV） infection on coronary artery lesion（ CAL）, treatment response and prognosis in children with Kawasaki disease（KD）. Methods A retrospective study of 105 inpatient children diagnosed with KD from Jan. 2003 to Dec. 2008 in Zhongnan hospital and Renmin hospital of Wuhan University were performed. Standardized clinical assessments, laboratory examination results and treatment regimens were reviewed. CALs were visualized by using echocardiography and serum specific antibodies of IgM, IgG were detected by indirect immunofluorescence test（IIF）. Results Among 105 KD children, 37.5% （36/96） were identified with CAL, 30 children with dilatation and 6 with aneurysm. Serum IgM levels against CMV were checked in 44 out of 105 children and 65.9% （29/44） cases were positive, 15 （34. 1% ） were negative. Among those IgM positive groups, the incidence of CALs was 52% （13/25） while 30.8% （4/13） in IgM negative groups （P 〈0.01 ）. CALs occurred in either both sides or left side of coronary artery, and no right side CAL was detected. More patients had polymorphous rash and peripheral edema in IgM （ ＋ ） groups compared to IgM （ - ） groups, while less had perianus desquamation in IgM （ ＋ ） groups（P 〈0.01 ）. In IgM （ ＋ ） groups, 5 cases（ 17.9% ） demonstrated no response to initial administration of intravenous immunoglobulin （IVIG）, while none in IgM （ - ） groups （P = 0.000）. Conclusion There is a high coincident of CMV infection in KD patients, which is closely related to the occurrence of CAL and resistant to IVIG therapy.

关 键 词：川崎病 巨细胞病毒 感染 

分 类 号：R725.4[医药卫生—儿科]