川崎病患儿787例冠状动脉病变情况随访  

Coronary arterial lesions in Kawasaki disease： a follow-up of 787 cases

作　　者：张晓梅 张利 刘德滢 刘金香[3] 王晶华[3] 杨思睿[3] 

机构地区：[1]内蒙古自治区人民医院儿科,呼和浩特010017 [2]内蒙古自治区呼和浩特疾病控制与预防中心体验科 [3]吉林大学第一医院儿科

出　　处：《中华风湿病学杂志》2014年第9期636-639,共4页Chinese Journal of Rheumatology

摘　　要：目的 调查吉林省和内蒙古自治区川崎病患儿冠状动脉损害情况,并初步评价应用糖皮质激素（GCs）对预后的影响.方法 对吉林省和内蒙古自治区32家县级以上医院1999-2012年确诊川崎病患儿进行了回顾性的研究,并对川崎病冠状动脉病变（CAL）发生情况、后遗症及GCs的作用进行研究.组间比较采用x2检验.结果 14年间共确诊810例川崎病患儿,其中787例进行了超声心动图检查,为本研究的研究对象.其中男童540例,女童247例,男女比例2.19：1,其中498例（63.3％）存在CAL.主要发生于58 d至14岁的患儿,平均年龄（2.7±2.4）岁,以冠状动脉扩张（390例,49.5％）和冠状动脉狭窄（105例,13.4％）为主;对不完全性川崎病与完全性川崎病及不同性别发生CAL间进行比较,发现差异无统计学意义;发生心脏后遗症共19例,占患者总数的2.4％,男女之比为3.67：1,对其发生情况及年龄分布分析表明：心脏后遗症以冠状动脉扩张为主,且发病年龄越小,发生CAL并发症的概率越高,遗留心脏后遗症的概率越高.对应用激素与CAL的发生情况进行研究发现,应用激素的患儿容易并发CAL[80.2％（97/121）与62.6％ （419/666）,χ2=8.71,P＜0.05].结论 川崎病并发CAL与完全性川崎病或不完全性川崎病及性别无关,与年龄有关：发病年龄越小,发生CAL的概率越高,遗留心脏后遗症的概率越高.GCs的应用有可能增加CAL的概率.Objective To investigate the coronary arterial lesions （CAL） in Kawasaki disease （KD） in Jilin Province and Inner Mongolia Autonomous Region from 1999 through 2012 and evaluate the influence of glucocorticoids （GCs） on prognosis.Methods We performed a retrospective study among patients of KD in Jilin Province and Inner Mongolia Autonomous Region from 1999 to 2012,in order to observe CAL in KD,the incidence of sequelae and the influence of CGs on disease outcome.Comparison between groups was carried out by Chi-square test.Results Eight hundred and ten KD cases were reported from 32 hospitals and 787 patients accepted an Echo examination,as the main objective of this study.Fivehundred and forty were boys and 247 were girls,with the male to female ratio of 2.19：1,of which 498 cases （63.3%） had CAL.Most CAL occurred in patients at 58 day to 14 year old （2.7±2.4）.The most common abnormality was CAL including dilatation （49.5%） and stenosis （13.4%）.Compared incomplete to complete KD,the result showed that the occurrence of CAL was similar between these two groups,no significant differences could be found between different gender.Nineteen （2.4%） of them had cardiac sequelae and the male/female ratio was 3.67：1.The younger the age,the higher the incidence of cardiac sequelae.The most frequent cardiac sequelae was coronary artery dilatation.GCs therapy could increase the occurrence of CAL [80.2%（97/121） vs 62.6% （419/666）,χ2=8.71,P〈0.05].Conclusion CAL is not different between patients with complete or incomplete KD and the occurrence of CAL is not associated with gender,but with age.The younger the age,the higher the incidence of CAL and the higher the incidence of cardiac sequelae.It is possible that patients treated with GCs are prone to CAL.

关 键 词：黏膜皮肤淋巴结综合征 糖皮质激素类 冠状动脉疾病 

分 类 号：R725.4[医药卫生—儿科]