感染因素对川崎病及其冠状动脉病变的影响

目的 探讨感染因素对川崎病(KD)及其冠状动脉病变的影响。 方法 回顾性收集首都医科大学附属北京儿童医院2005年1月至2014年12月出院诊断中包含KD的病历，截取人口学信息、临床发现、急性期和后遗症期超声心动图发现、转归，对每份病历重新行典型KD、不完全KD、IVIG抵抗、冠状动脉病变及其程度和合并感染的甄别。分为KD感染组、KD非感染组分析组间临床发现的差异，分为冠状动脉病变组、非冠状动脉病变组分析感染因素的差异。 结果 2 331例KD患儿进入分析。KD合并感染的发生率为57.1% (1 331/2 331)，KD并发冠状动脉病变的发生率为36.0%(840/2 331)。KD感染组与KD非感染组年龄、发热天数及不完全KD比例差异有统计学意义(P均<0.05)；冠状动脉病变组与非冠状动脉病变组肺炎支原体感染及消化系统感染伴发腹泻比例差异有统计学意义(P均<0.05)。 结论 合并感染的KD患儿年龄多<1岁，易表现为不完全KD，合并肺炎支原体感染及消化系统感染伴发腹泻的KD患儿易发生冠状动脉病变。

Influence of infection on Kawasaki disease and coronary artery lesions

Objective To explore the influence of infection on Kawasaki disease (KD) and coronary artery lesions. Methods We retrospectively reviewed the clinical records of patients with KD treated at Beijing Children's Hospital, Capital Medical University from January 2005 to December 2014, the intercepted demographic information, clinical findings, echocardiography findings of acute and sequelae phase and outcomes. The typical KD, incomplete KD, IVIG resistance, the degree of coronary artery lesions and co-infection were re-screened for each case. The differences of clinical manifestations were analyzed between the infected group and non-infected group. The differences of infections were analyzed between the coronary artery lesions group and non-coronary lesions group. Results The proportion of KD combined with infection and KD combined with coronary artery lesions was 57.1% (1331/2 331) and 36.0%(840/2 331), respectively. There were significant differences in age, length of fever (days) and incomplete KD. There were significant differences in mycoplasma pneumoniae infection and gastrointestinal infections associated with diarrhea between the coronary artery lesions group and non-coronary lesions group (P values were 0.004 and 0.047, respectively). Conclusion This study showed that KD children with infection were common in patients below 1 year old and characterized by incomplete KD. KD children with mycoplasma pneumoniae infection and gastrointestinal infection associated with diarrhea were prone to develop coronary artery lesions.