不完全川崎病并发冠状动脉瘤破裂死亡1例并文献复习  

Incomplete Kawasaki disease complicated with rupture of coronary aneurysm:a case report and literature review

作　　者：吴振波[1,3] 邓筹芬[1] 谭晓辉 Wu Zhenbo;Deng Choufen;Tan Xiaohui(Department of Pediatrics,Jiangmen Maternal and Child Health Hospital,Jiangmen 529000,China;School of Forensic Medicine,Southern Medical University,Jiangmen 529000,China)

机构地区：[1]广东省江门市妇幼保健院儿科,529000 [2]南方医科大学法医学院,广东江门529000 [3]广东省江门市妇幼保健院儿内科

出　　处：《国际医药卫生导报》2021年第15期2363-2366,共4页International Medicine and Health Guidance News

摘　　要：目的报道3个月龄以下婴儿猝死、尸体解剖鉴定为川崎病(KD)冠状动脉瘤破裂1例,以提高临床医生对小婴儿KD的认识和警惕。方法回顾该病例的临床资料,并查阅中外文献进行复习分析。结果本例KD临床表现不典型,伴有肺部感染,进行抗感染后热退、症状改善,但白细胞计数(WBC)、血小板计数(PLT)、C-反应蛋白(CRP)持续升高,红细胞压积(HCT)降低,临床未警惕到不完全KD可能,最终发展为KD冠状动脉瘤破裂死亡。结论小婴儿KD往往没有典型的临床症状,并常伴有冠状动脉损伤,应及时行超声心动图鉴别诊断,有适应证及早使用静脉注射用丙种球蛋白(IVIG),对减轻或减少冠状动脉的损害,防止冠状动脉瘤形成、血栓性阻塞等严重并发症的发生至关重要。Objective To report an under 3 months old infant who suddenly died and was identified as ruptured coronary aneurysm caused by Kawasaki disease(KD)by autopsy,and to raise clinicians'vigilance and awareness about KD in infants.Methods This case's clinical data were analyzed,and the literatures abroad and at home were reviewed and analyzed.Results This case's clinical manifestations of KD were not typical,with pulmonary infection;after anti-infective therapy,its fever regressed and its manifestations were improved,but the total number of white blood cells(WBC),C-reactive protein(CRP),and the total number of platelets(PLT)continuously increased,and hematocrit(HCT)decreased.The clinicians didn't notice the possibility of clinical incomplete KD,and the infant eventually developed into coronary artery rupture from KD and died.Conclusion The clinical manifestations of KD in infants are often atypical,and the incidence of coronary artery disease is high.The differential diagnosis by echocardiography should be performed in time.Early usage of intravenous immunoglobulin(IVIG)may reduce the damage on coronary arteries and prevent the formation of coronary aneurysms and thrombotic obstruction which are very fatal.

关 键 词：川崎病 冠状动脉损害 冠状动脉瘤 小婴儿 

分 类 号：R725.4[医药卫生—儿科]