摘要
目的探讨川崎病(KD)的临床特征、实验室检查、冠脉损害的相关因素及治疗。方法对南京市儿童医院2005年3月至2009年2月诊治的281例KD患儿的病历资料进行回顾性分析和总结。结果 281例KD中不完全性KD 53例(18.9%),对静脉丙种球蛋白(IVIG)治疗无反应的KD 12例(4.27%),男性191例,女性90例,男女比例约为2.1∶1。年龄最小2个月,最大13岁。<1岁87例,1～3岁121例,3～5岁42例,>5岁31例。平均发病年龄2岁3个月。急性期合并损害冠脉者74例(26.3%),其中冠脉扩张41例(14.6%),小冠脉瘤26例(9.3%),中等冠脉瘤7例(2.5%)。住院2周后新发生的冠脉扩张22例(10.6%)。冠脉损害者随访6个月至3年,完全恢复正常者67例,其中1例对IVIG治疗无反应患儿,住院2周后出现巨大冠状动脉瘤,随访2年完全恢复正常。结论川崎病冠脉损伤与发热持续时间、血红蛋白(Hb)、血小板(PLT)、血沉(ESR)有关。KD发病10 d内用IVIG效果好,2 g/kg单次注射优于1 g/(kg.d)连用2 d的疗法。
Objective To investigate the clinical features,laboratory examination,risk factors of coronary artery lesions and treatment for Kawasaki disease（KD）.Methods A total of 281 patient with KD hospitalized in Nanjing Children’s Hospital during March 2005 and February 2009 were reviewed.Results Among 281 cases,53 cases（18.9%） were diagnosed with incomplete KD;12 cases（4.27 %） were diagnosed IVIG refractory KD;191 cases were male and 90 were female,male to female ratio being 2.1：1.The age was from 2 months to 13 years old.87 cases were under 1 year old,121 from 1 to 3 years old,42 from 3 to 5 years old and 31 over 5 years old.The mean age was 2 years and 3 months.A total of 74 cases were complicated with CAL（26.3%）,including 41 coronary artery dilations（14.6%）,26 small coronary artery aneurysms（9.3%） and 7 medium coronary artery aneurysms（2.5%）.Two weeks after intravenous IVIG treatment,the new cases of coronary abnormalities were 22/207（10.6%）.The patients with CAL were followed up from 6 months to 3 years,67 cases regressed completely.Among these 1 incomplete KD case occurred giant coronary artery aneurysm at two weeks after hospitalization.Followed up for two years,this patient was regressed normal completely.Conclusion The risk factors of CAL include persistent fever,low hemoglobin,high platelet,and high erythrocyte sedimentation rate（ESR）.Children receiving IVIG 2g/kg in the early 10 days of KD have little chance of CAL.The single dose of 2g/kg IVIG administration has better effect than twice of 1g/kg.
出处
《安徽医学》
2012年第1期29-32,共4页
Anhui Medical Journal
关键词
川崎病
不完全川崎病
冠脉损害
丙种球蛋白
Kawasaki disease
Incomplete Kawasaki disease
Coronary artery lesion
Gamma globulin
