| 王书书,潘家华.2005—2014年428例川崎病住院患儿临床分析[J].安徽医药,2016,20(3):475-479. |
| 2005—2014年428例川崎病住院患儿临床分析 |
| The analysis of 428 cases with Kawasaki disease in the 10 years of 2005—2014 |
| 投稿时间：2015-10-11 |
| DOI： |
| 中文关键词: 川崎病 大剂量丙球 冠状动脉损害 不完全川崎病 |
| 英文关键词: Kawasaki disease high dose gammaglobulin coronary artery lesions incomplete Kawasaki disease |
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| 中文摘要: |
| 目的 分析总结2005—2014年10年间428例川崎病(KD)患儿的人群特征、病程特点、治疗及冠状动脉累及情况。方法 回顾性复习 2005—2014年安徽省立医院儿内科收住的川崎病患儿的病例资料,统计并比较前后5年发病年龄、性别、入院时间、病程特点、实验室检查、丙球静脉注射(IVIG)治疗及冠状动脉损害(CAL)发生率,予Graphpad 软件作图,SPSS 16.0 统计分析。结果 10年间入住安徽省立医院儿内科的428例川崎病患儿中,最小6个月,最大13岁,主要分布在1~5岁患儿291 例(67.99%)；男女性别比为1.8∶1(男275例,女153例)；每年平均住院人数(42.30±10.21)例,入院季节以春夏季节最多,患儿平均年龄30个月；近5年诊断不完全川崎病患儿明显上升(χ2=3.93,P<0.05)；实验室指标方面:入院时患儿白细胞(WBC)增高、C-反应蛋白(CRP)上升、血沉(ESR)增快、谷丙转氨酶(ALT)上升、血清白蛋白(ALB)下降、钠(Na) 下降的发生率分别为86.21%、 93.46%、97.20%、25.70%、76.64%、40.19%；入院时WBC增高、CRP增高、ESR增快、及ALT升高、Na降低的患儿发生冠状动脉损伤未见明显增多；而入院时低蛋白血症、经治疗体温正常后复查血沉无下降或反而继续升高者冠状动脉损伤发生率明显增高；近5年患儿出现IVIG抵抗的发生率为14.87%、冠状动脉损害的发生率为13.30%,分别与前5年相比未明显增多。近5年不完全川崎病(IKD)诊断55例,占23.61%,较前5年31例有增多趋势(P<0.05),但总热程(6.77± 1.61)d,较前5年明显缩短(t=6.62,P<0.05)。结论 近5年住院患儿中小婴儿、不完全川崎病有增多趋势,并且合并低蛋白血症、体温正常后复查血沉仍未下降是冠状动脉损害的高危因素；总热程明显缩短,且冠状动脉损害的发生率并没有增多,与及时给予IVIG治疗密切相关。IVIG抵抗现象一直存在,应引起临床医师的高度重视。 |
| 英文摘要: |
| Objective Analyze and summarize population characteristics and clinical features of 428 cases of children with Kawasaki disease hospitalized in pediatrics department in Anhui Provincial hospital in the 10 years of 2005—2014. Methods A retrospective review of age,gender,admission time,duration characteristics (clinical,laboratory parameters,IVIG therapy ) and the incidence of coronary artery lesions of purpose population was conducted. Graphpad software and spss 16.0 were used for statistical analysis. Results The age ranged from six months to 13 years,with 291 cases (67.99%) of 1~5 year-old children dominated in the 428 patients in pediatrics department in Anhui Provincial Hospital in the years of 2005—2014. The ratio of male to female was 1.8∶1 (male 275 cases,female 153 cases). The average number of hospitalizations was (42.30 ± 10.21) cases/year,with the most seasons of admission in spring and summer,the average age was 30 months. Cases of incomplete Kawasaki disease was significantly increased (χ2 =3.93,P<0.05) during 2010—2014. Laboratory parameters:The incidence rates of 86.21%,93.46%,97.20%,25.70%,76.64%,40.19% happened in the 428 children with elevated WBC,increased CRP,faster ESR,rised Alt,low level of ALB and decreased Na+ separately. The children who has increased leukocyte,increased CRP,faster ESR,increased alanine aminotransferase,and reduced Na+ showed no significant differences in the occurrence of coronary artery lesions while hypoproteinemia,increasing or failed-to-decline erythrocyte sedimentation rate after treatment when temperature is normal showed significantly higher incidence of coronary artery lesions. In the years of 2010—2014,IVIG resistance was occurred in 14.87% patients and the occurrence of coronary artery lesions was 13.30%,which is not significantly increased compared with the years of 2005—2009. In the years of 2010—2014,5 cases were diagnosed as IKD,accounting for 23.61%,overtaking the number of 31 cases in the previous five years,with a growing trend (P <0.05). However,the total thermal process lasted (6.77±1.61) days,which became shorter compared with the previous five years (t = 6.62,P <0.05).Conclusion In recent years patients with younger age as well as diagnosis of incomplete Kawasaki disease displayed a growing trend. In addition,the hypoproteinemia,the index that ESR failed to decline when body temperature decreased to normal after IVIG treatment indicated the risk factors for coronary artery lesions. The total thermal process became significantly shorter and the incidence of coronary artery lesions were not significantly increased due to the timely IVIG therapy.IVIG resistance phenomenon lasted,which should be paid more attention. |
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