儿童复发川崎病的临床分析  

Clinical analysis of recurrent Kawasaki disease in children

作　　者：褚馨远 陈希[1] 李奇蕊 甄珍[1] 高路[1] 于文 袁越[1] Chu Xinyuan;Chen Xi;Li Qirui;Zhen Zhen;Gao Lu;Yu Wen;Yuan Yue(Department of Cardiology,National Children′s Medical Center,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院心脏内科,100045

出　　处：《中国小儿急救医学》2021年第9期806-809,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的分析儿童复发川崎病的临床特征,为复发川崎病的诊断与治疗提供一定的理论依据。方法2016年1月至2019年12月入住首都医科大学附属北京儿童医院的川崎病患儿,选择复发病例,比较患儿初发时与复发时的临床表现、辅助检查、治疗情况等。结果4年间共收治确诊川崎病患儿3041例,其中复发65例,男∶女为3.1∶1,复发时年龄(2.42±2.04)岁。复发时患儿发热热程为(5.66±2.37)d,较初发时明显缩短,且皮疹、四肢改变发生率较初发时有所降低,但常伴随呼吸道与消化道症状。65例复发患儿中,初发时出现冠状动脉损害的患儿19例(29.2%),其中15例复发时冠状动脉损害有所减轻;另有11例患儿复发时出现新的冠状动脉损害。65例复发患儿中,9例患儿初发时考虑为静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG)无反应型川崎病,但其中5例复发时IVIG初始2 g/kg后症状即明显改善;共12例患儿复发时考虑为IVIG无反应型川崎病。结论儿童川崎病复发多发生于初次发病1年内,且3岁以下儿童多见。多数患儿复发时发热热程短于初发,主要临床表现较初发时不典型。部分患儿初发时初始IVIG治疗有效,但复发时IVIG无反应,需应用糖皮质激素或英夫利昔单抗等治疗。Objective To provide a theoretical basis for diagnosing and treating recurrent Kawasaki disease based on data analysis of clinical symptoms.Methods Data analysis of children with recurrent Kawasaki disease admitted to Beijing Children′s Hospital of Capital Medical University from January 2016 to December 2019 was conducted,including comparisons of the initial onset and the recurrence on patients′clinical features,auxiliary examination and treatment.Results During the four-year scale,3041 children with Kawasaki disease were admitted to the department of Cardiology.The recurrence data involved 65 children[male∶female 3.1∶1,average aged(2.42±2.04)years].First,children′s fever duration was(5.66±2.37)days in recurrence data,significantly shorter than that of their initial onset.The recurrence data also reported a lower incidence of rash and limb changes,together with respiratory and gastrointestinal symptoms.Then,19 cases out of the 65 children got coronary artery lesion(CAL)at their initial onset.A relief of CAL was reported from 15 children when the disease recurred,along with 11 new-reported CAL cases.Intravenous immunoglobulin(IVIG)refractory Kawasaki disease cases accounted for nine at the initial onset and 12 at the recurrent onset,respectively.Five IVIG refractory recurrent cases reported significant relief after 2 g/kg IVIG treatment.Conclusion The recurrent Kawasaki disease in children usually occurs among children under three years old,within the first year after the initial onset.Most of the recurrent cases report a shorter fever duration and less typical clinical symptoms than their first onset.In some cases,IVIG treatment showed effects initially but failed to work when the disease recurred.Therefore,glucocorticoid or infliximab should be considered for further treatment.

关 键 词：冠状动脉损害 川崎病 英夫利昔单抗 静脉注射免疫球蛋白 热程 糖皮质激素 北京儿童医院 消化道症状 

分 类 号：R725.4[医药卫生—儿科]