5岁以上年长儿川崎病临床特征分析  

Clinical features of children with Kawasaki disease aged over 5 years

作　　者：田芳 张静[1] 肖蘭 TIAN Fang;ZHANG Jing;XIAO Lan(Children＇s Hospital of Chongqing Medical University/National Demonstration Base of Standardized Training Base for Resident Physicians/Ministry of Education Key Laboratory of Child Development and Disorders/Key Laboratory of Pediatrics in Chongqing/Chongqing International Science and Technology Cooperation Center for Child Development and Disorders,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院/国家住院医师规范化培训示范基地/儿童发育疾病研究省部共建教育部重点实验室/儿科学重庆市重点实验室/重庆市(儿童发育重大疾病诊治与预防)国际科技合作基地,重庆400014

出　　处：《中国当代儿科杂志》2018年第11期917-920,共4页Chinese Journal of Contemporary Pediatrics

摘　　要：目的总结5岁以上儿童川崎病(KD)的临床及实验室特征。方法将确诊为KD或不完全KD的250例年长儿分为>5～9岁(191例)及>9岁亚组(59例),与266例1～5岁KD患儿进行回顾性分析比较,比较3组间的临床及实验室特点。结果 3组间手足肿胀、指端或肛周脱屑的发生率均以>9岁组最低,而颈淋巴结肿大的发生率以>5～9岁组最高,总热程以>9岁组最长(P<0.05)。3组间皮疹、球结膜充血、口唇改变的发生率及不完全KD所占比例、静脉丙种球蛋白(IVIG)无反应发生率的差异无统计学意义(P>0.05)。PLT、白蛋白水平以>9岁组最低,中性粒细胞百分比以>5～9岁组最高(P<0.05)。3组间WBC总数及CRP、ESR、ALT的差异无统计学意义(P>0.05)。轻度冠脉扩张以1～5岁组最多,中型冠状动脉瘤的发生以>9岁组最多(P<0.05);3组间巨大冠脉瘤发生率的差异无统计学意义(P>0.05)。结论 5岁以上年长儿KD临床表现不典型,但颈部淋巴结肿大发生率和中性粒细胞百分比相对较高,PLT及白蛋白水平偏低。年龄越大发生中型冠状动脉瘤的风险越大。Objective To study the clinical and laboratory features of children with Kawasaki disease（KD） aged 〉5 years. Methods A retrospective analysis was performed for the clinical data of 250 elderly children（aged 〉5 years） who were diagnosed with KD or incomplete KD（divided into 5-9 years and 〉9 years groups） and 266 KD children aged 1-5 years. Clinical and laboratory features were compared between groups. Results The 〉9 years group had the lowest incidence rates of hand and foot swelling and fingertip or perianal desquamation（P〈0.05）. The 5-9 years group had the highest incidence rate of neck lymph node enlargement（P〈0.05）. The 〉9 years group had the longest course of fever（P〈0.05）. There were no significant differences among the three groups in the incidence rates of rash, bulbar conjunctival hyperaemia and the change in lips, the proportion of children with incomplete KD, and the proportion of children with no response to intravenous immunoglobulin（IVIG）. The 〉9 years group had the lowest platelet count and albumin（P〈0.05）. The 5-9 years group had the highest percentage of neutrophils（P〈0.05）. There were no significant differences among the three groups in white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and alanine aminotransferase（P〉0.05）. As for the degree of CAL, the 1-5 years group had the highest incidence of mild coronary dilation, and the 〉9 years group had the highest incidence rate of moderate coronary aneurysm（P〈0.05）. There was no significant difference in the incidence rate of large coronary aneurysm among the three groups（P〉0.05）. Conclusions KD children aged 〉5 years have atypical clinical manifestations, with a high incidence rate of neck lymph node enlargement, a high percentage of neutrophils, and a low level of albumin and platelet. The risk of moderate coronary aneurysm increases with age.

关 键 词：川崎病 颈部淋巴结肿大 冠状动脉损伤 年长儿 

分 类 号：R725.4[医药卫生—儿科]