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??Abstract??Objective To explore the risk factors in children with coronary artery lesion ??CAL?? complication in Kawasaki disease??KD??. Methods Retrospective analyses of the clinical data from 143 children with KD from 2009 to 2011 in Shandong Provincial Hospital were performed in terms of 11 aspects including the fever duration??hemoglobin ??Hb????erythrocyte sedimentation rate ??ESR????C-reaction protein ??CRP????white blood cell count ??WBC????blood platelet ??PLT????and the patients??gender and age. 143 children were divided into two groups according to whether these KD patients were with or without CAL.Both single factor and multivariate logistic regression analyses were performed. Results Single factor analysis showed that fever duration over 10 days??ESR??PLT??CRP??ALB??cTnI and NT-porBNP were risk factors to KD complicated with CAL ??P??0.05 or P??0.01??.Multivariate logistic regression analysis showed that a fever duration over 10 days??decrease of ALB and increase of cTnI were significant risk factors to KD complicated with CAL??P??0.05??. Conclusion Fever duration over 10 days??decrease of ALB and increase of cTnI are important risk factors to KD complicated with CAL.     

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目的探讨川崎病(KD)患儿合并冠状动脉损伤的危险因素。方法按照KD诊断标准,对北京儿童医院2000-01-01—2004-12-31收治的644例KD患儿临床资料、治疗方法以及实验室资料进行分析。结果Pear-son卡方检验显示,患儿性别、发热持续时间、丙种球蛋白使用时间、丙种球蛋白使用剂量、血沉及C反应蛋白与KD合并冠状动脉损伤有关(P<0·05);进一步多因素Logistic回归分析显示,性别、发热持续时间、丙种球蛋白使用剂量与冠状动脉扩张显著独立相关(P<0·05)。结论对男性、发热持续时间长的KD患儿应予足够重视,早期足量使用丙种球蛋白以减少或减轻冠状动脉并发症。     

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目的探讨川崎病(KD)发生冠状动脉病变(CAL)的危险因素。方法回顾性分析2000年1月至2004年12月期间942例住院KD患儿的临床资料,对发生CAL(170例)和未发生CAL(772例)的病例进行组间对照研究,对13种影响CAL发生的因素进行Logistic回归分析。结果Logistic回归分析结果表明,热程大于10d(X1)的OR值为1.203(95%CI=1.104～1.312,P<0.001)、血红蛋白(Hb)小于100g/L(X2)的OR值为0.658(95%CI=0.472～0.995,P<0.05)。建立KD发生CAL的危险因素主效应模型是Logit(P)=β0(-2.995)+0.185X1+(-0.378)X2(χ2=16.920,P=0.031)。结论热程大于10d、Hb<100g/L是KD发生CAL的高危因素。     

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??Abstract?? Objective To analyze the characteristics and risk factors of coronary artery lesions ??CAL?? in Kawasaki disease ??KD?? based on the clinical grading. Methods The clinical records of 1253 KD patients admitted to Children’s Hospital of Fudan university from January 2000 to June 2011 were analyzed retrospectively. Results ??1??Coronary arterial lesions occurred in 304 cases with the incidence of 24.3% in KD patients. According to the clinical grading of CAL of KD?? among 304 CAL patients?? 32 cases ??10.5%?? were grade II??251 cases ??82.6%?? were grade ?? 13 cases ??4.3%?? were grade ????and 8 cases??2.6%?? were grade V?? with the prevalence in KD patients of 2.6%??20.0%??1.0%??and 0.64% respectively. ??2??In all CAL patients?? single?? double?? three and four coronary branch lesions accounted for 42.4%?? 29.3%??16.1% and 12.2% respectively. The lesions of left main trunk??left anterior descending branch??left circumflex branch and right coronary artery accounted for 43.5 %??18.6%??6.8 % and 31.1% of all the branches involved respectively. ??3??The results of single factor analysis and multivariate logistic regression analysis showed that incomplete KD and elevated C reactive protein ????100 mg/L?? were the risk factors of grade ?? CAL?? while male sex?? age younger than 1 year?? duration of fever over 10 days?? incomplete KD and low serum albumin ????30 g/L?? were the risk factors of Grade ????CAL. Conclusions ??1??Grade III CAL is the most common type in KD patients, accounting for 82.6% of CAL. ??2??About 57.6% CAL occurs in two and abovetwo branches of coronary arteries. ??3??The most frequently involved branch is left main trunk, followed by right coronary artery??left anterior descending branch and circumflex branch. ??4??Being male?? age??1 year old?? incomplete KD?? long-lasting fever ????10 d?? and low serum albumin ????30 g/L?? are the independent risk factors of grade ????CAL.     

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??Objective??To study clinical characteristics and risk factors for mortality of septic shock patients with hematological malignancies in pediatric intensive care unit??PICU??. Methods??A retrospective analysis of records of pediatric patients with hematological malignancy and septic shock was performed. In our study??43 cases admitted to PICU in Sun Yat-sen Memorial Hospital between March 2012 and September 2015 were included. Results??Among the 43 cases??16 died??while the other 27 survived. The percentage of mortality was 37.2%. Pulmonary infection ??74.4%?? and gastrointestinal tract infection??39.5%?? were the common causes of septic shock in these patients. Etiological examination revealed 43 kinds of pathogenic bacteria in 26 cases. The percentage of gram-positive bacteria??gram-negative bacteria and fungus was 11.6%??72.1% and 16.3%??respectively. Escherichia coli was found to be the main pathogen??6/43??14.0%??. Between the survival group and the mortality group??there were significant differences in the parameters of age??chemotherapy courses??time from infection to shock??time from neutropenia to shock??multiple organs dysfunction??pulmonary infection??hypocalcemia??oxygenation index and serum lactic acid concentration after 6 hours of fluid resuscitation??requirement of dopamine and mechanical ventilation ??P??0.05??. By logistic regression analysis??mortality was associated with the variables of serum lactic acid concentration after 6 hours of fluid resuscitation and requirement of mechanical ventilation. Conclusion??The risk factors for mortality of septic shock in pediatric patients with hematological malignancies are hyperlactacidemia after 6 hours of fluid resuscitation??hypocalcemia and requirement of mechanical ventilation.     

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目的研究与法洛四联症(TOF)一期根治手术早期死亡相关的危险因素。方法回顾1995年4月至2004年3月在复旦大学附属儿科医院心血管中心行一期根治术的TOF病例152例,术后早期死亡17例,对其术前、术中27个可能的危险因素指标与术后早期死亡的关系进行单因素和多因素分析。结果单因素分析结果显示与术后早期死亡有关的指标包括手术时体重、发生青紫年龄、动脉血氧饱和度、升主动脉与肺动脉干直径比AO/MPA、McGoon比值、Nakata指数、肺体循环血流量之比Qp/Qs、右向左分流量占体循环血流量比例(QseQp)/Qs、体肺侧支循环和跨瓣补片。多因素分析结果显示AO/MPA和McGoon比值与手术早期死亡有关。结论肺动脉的发育情况是TOF一期根治术后能否生存的关键。手术病例的选择需要综合考虑多种危险因素。     

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目的探讨影响小儿绿脓杆菌败血症病死率的因素。方法回顾性分析1991～2003年间中山医科大学附属第一医院收治的16例14岁以下绿脓杆菌败血症患儿的临床资料。结果发热和腹泻为最常见的初始症状。病死率与性别、年龄、感染途径、是否化疗和使用激素、白细胞数无关(P>0.05),而与基础疾病的严重程度、有无严重并发症、有无低钠血症、高血糖症、血小板减少及有无敏感抗生素联合用药有关(P<0.05)。结论绿脓杆菌败血症是免疫功能低下患儿的常见危重并发症之一,病死率极高,早期经验性联合应用抗绿脓杆菌抗生素可能在一定程度上降低病死率。     

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目的分析儿童静脉注射免疫球蛋白(IVIG)不敏感川崎病的临床特点。方法对2005-01—2005-12在重庆医科大学儿童医院住院的233例川崎病的患儿进行病例回顾性分析。结果IVIG不敏感川崎病共31例(占13.3%)。IVIG不敏感川崎病中男女性别比为4.17∶1,明显高于IVIG敏感川崎病1.43∶1(P<0.05)。两组川崎病年龄构成差异无显著性(P>0.05)。IVIG不敏感川崎病中有中度以上冠状动脉扩张或冠状动脉瘤者6例(6/31,19.4%),明显高于IVIG敏感川崎病(5/202,2.4%)(P<0.05)。川崎病患儿发生IVIG耐药的可能危险因素有外周血白细胞、中性粒细胞比例、血红蛋白、C反应蛋白、血沉、血浆白蛋白、乳酸脱氢酶等,分析结果提示血浆白蛋白降低及男性可能与IVIG不敏感川崎病有关,但仅此两项指标尚不能预测IVIG不敏感川崎病的发生。IVIG不敏感川崎病冠脉病变发生危险因素无阳性发现。IVIG不敏感川崎病患儿中14例通过复用IVIG后临床症状得以缓解,仅8例在复用IVIG后症状仍不能控制而加用激素治疗。结论IVIG不敏感川崎病并不少见且较IVIG敏感川崎病更易发生较严重冠状动脉病变,川崎病患儿发生IVIG耐药及IVIG不敏感川崎病冠脉病变发生的危险因素不肯定。复用IVIG及必要时在抗凝基础上加用激素对IVIG不敏感川崎病治疗有较好疗效。     

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目的分析川崎病(KD)并发冠状动脉瘤(CAA)的高危因素及预后。方法回顾性分析重庆医科大学附属儿童医院1993年1月至2009年12月3902例住院KD患儿的临床资料,对与冠状动脉损害发生有关的因素进行计数资料χ2检验、计量资料t检验,将单因素分析筛选出的变量行多因素Logistic回归分析;对随访的46例CAA患儿病后1、3、6个月和1、2、3、4、5年及5年以上CAA的恢复情况及不同剂量静脉注射丙种免疫球蛋白(IVIG)的远期疗效进行χ2检验。结果 (1)单因素分析结果:性别、年龄、热程、IVIG使用时机、血红蛋白(Hb)、红细胞沉降率(ESR)、血清白蛋白与KD并发CAA有关(P<0.05),将单因素分析筛选出的上述因素作为自变量进一步行多因素分析,结果显示,Hb、ESR、IVIG使用时机与KD并发CAA呈独立相关性(P<0.05),而性别、年龄、热程、血清白蛋白与KD并发CAA非独立相关(P>0.05);(2)小型CAA、中型CAA、巨大CAA的回缩时间逐渐延长(P<0.05),年龄及IVIG的剂量与CAA的回缩时间无统计学相关性(P>0.05)。结论 Hb<100 g/L、ESR>50 mm/h、I...     

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??Objective To explore the main risk factors of neonatal pneumothoraxand to provide a basis for early clinical intervention and treatment. Methods A retrospective study was conducted at the neonatal intensive care unit??NICU?? of the Children’s Hospital of Soochow University in 67 infants with neonatal pneumothorax and 60 infants without neonatal pneumothorax from January 2012 to December 2014 .The data was compared by univariate and multivariate Logistic regression analysis. Results Univariate analysis showed that gestational age??pneumonia??neonatal respiratory distress syndrome??NRDS????cesarean section??resuscitation intrapartum??continuous positive airway pressure??CPAP????meconium aspiration syndrome??MAS????wet lung??TTN?? and mechanical ventilation were the risk factors for neonatal pneumothorax??P??0.05??. Logistic regression analysis showed that gestational age??NRDS??CPAP??mechanical ventilation??cesarean section??MAS??TTN and pneumonia were the main risk factors for neonatal pneumothorax??OR values were 6.442??9.933??8.690??27.873??5.051??38.405??11.692 and 9.493??P??0.05??. Conclusion The main risk factors for neonatal pneumothorax are gestational age??NRDS??CPAP??mechanical ventilation??cesarean section?? MAS??TTN and pneumonia.     

静脉丙种球蛋白无反应性川崎病的治疗及危险因素分析

目的探讨首次丙种球蛋白静脉注射(IVIG)无反应性川崎病(KD)的发生率及危险因素,及其再治疗方法的选择。 方法总结2000—2004年北京45家医院KD患儿的临床资料,IVIG无反应性定义为首次IVIG治疗36h后体温仍超过38.5℃。 结果1107例患儿纳入研究对象,1092例有急性期治疗资料,1052例(96.3%)接受IVIG治疗,135例对首次IVIG治疗无反应,发生率12.8%(135/1052)。Logistic回归分析发现血沉、GPT、WBC、发病至用IVIG的时间、血浆白蛋白及IVIG治疗剂量,是IVIG无反应性的独立危险因素(P<0.05)。对IVIG无反应者8例给第2剂2g/kg IVIG,5例热退;114例给1g/kg剂量IVIG治疗,35例(30.7%)热退;11例给400~600mg/kg IVIG,1例(9.1%)热退;2例给糖皮质激素,2例均热退。4种再治疗方法间比较,差异有统计学意义(P=0.015)。第2剂2g/kg IVIG治疗较其它再治疗所需进一步IVIG或激素治疗次数少,体温恢复快。 结论约12.8%KD患儿对初次IVIG治疗无反应。血沉、WBC和GPT、血浆白蛋白、IVIG使用方法及起病至用IVIG的时间,是IVIG无反应的独立危险因素。对初次IVIG无反应患儿推荐使用第2剂2g/kgIVIG,对2次2g/kg IVIG治疗仍无效者可以选用糖皮质激素治疗。     

Kawasaki disease

Kawasaki disease (KD) is a systemic necrotizing vasculitis affecting medium and small sized arteries. 13 The diagnosis is based entirely on recognition of a typical sequence of clinical features. Detection of any one clinical feature does not have any diagnostic significance. We report an uncommon case of Kawasaki disease in 10 months old male child with the analysis of its natural history, etiopathology, treatment and prognosis of the disease.     

激素与静脉丙种球蛋白及其联合应用治疗静脉丙种球蛋白无反应川崎病的回顾性对照研究

目的 探讨激素对静脉丙种球蛋白（IVIG）无反应川崎病（KD）患儿的治疗价值。方法 回顾性收集重庆医科大学附属儿童医院IVIG无反应KD住院患儿,根据再治疗情况分为IVIG组、激素组和IVIG+激素组;将应用激素者根据激素应用途径分为静脉滴注序贯口服激素组和口服激素组。统计各组患儿的总热程、平均热退时间、治疗前后实验室检查结果并计算治疗前后的差值与治疗前值的比值（即差值比△）、急性期及出院后6、12、24个月冠状动脉病变和随访中的血栓形成情况。结果 IVIG无反应KD患儿143例进入本文分析。IVIG组107例,激素组12例, IVIG+激素组24例,3组性别、年龄、体重差异无统计学意义。IVIG+激素组治疗后WBC高于IVIG组,△WBC、△PLT均低于IVIG组,△CRP高于IVIG组,总热程长于IVIG组;急性期冠状动脉瘤发生率及随访至6个月时冠状动脉扩张发生率高于IVIG组,差异均有统计学意义;激素组△WBC低于IVIG组,总热程长于IVIG组,差异均有统计学意义。静脉滴注序贯口服激素组和口服激素组各18例,2组性别、年龄、体重差异无统计学意义,口服激素组再次治疗前和再次治疗后CRP均低于静脉滴注序贯口服激素组, 口服激素组△PLT高于静脉滴注序贯口服激素组,2组随访时点冠状动脉扩张和冠状动脉瘤发生率差异均无统计学意义。随访病例中,静脉滴注序贯口服激素组有2例出现血栓,经积极抗凝治疗后血栓消失。结论 IVIG无反应KD患儿再治疗时应用激素或再次IVIG无反应后应用激素,与单纯IVIG相比急性期治疗效果相近,且均不增加远期冠状动脉损伤的发生率;选择普通剂量口服或者静脉滴注序贯口服疗法临床效果相近,但静脉滴注序贯口服激素较口服激素有更高的血栓形成风险。     

Infantile Kawasaki disease and peripheral gangrene

We report a 1-month-old infant with Kawasaki disease and peripheral gangrene. We advocate using the newly published American Heart Association guidelines advising early laboratory and echocardiogram investigations in infants with fever but without other classic manifestations of Kawasaki disease. Initiation of early therapy may prevent this serious complication with its permanent sequelae.     

不同评分体系对重庆地区静脉丙种球蛋白无反应川崎病预测能效评价

目的 评价4种评分体系对中国儿童静脉丙种球蛋白（IVIG）无反应川崎病(KD)的预测能效,并探讨重庆地区儿童发生IVIG无反应KD的危险因素。 方法 纳入重庆医科大学附属儿童医院住院的符合KD诊断标准并接受IVIG 2 g·kg-1联合阿司匹林治疗的首诊患儿,以IVIG无反应KD连续样本为IVIG无反应组;并随机抽取IVIG有反应KD作为IVIG敏感组,样本量与IVIG无反应组1∶1对照。应用Kobayashi、Egami、Sano及Fu等4种评分体系对IVIG敏感组和无反应组进行评分,采用单因素分析及多因素logistic回归分析,寻找重庆地区儿童发生IVIG无反应KD的危险因素,通过对危险因素进行赋值,得出新的评分体系。 结果 IVIG无反应组和IVIG敏感组各纳入140例。①Kobayashi、Egami、Sano及Fu法的敏感度分别为0.443、0.364、0.207和0.457,特异度分别为0.843、0.857、0.957和0.75,约登指数分别为0.286、0.221、0.164和0.207。②单因素分析显示颈部淋巴结肿大、多形性皮疹、PLT、中性粒细胞分类、CRP、血清总胆红素和血清白蛋白与IVIG无反应KD相关,多因素分析提示多形性皮疹、PLT和CRP是IVIG无反应KD的危险因素。③新的评分体系多形性皮疹（2分）,PLT≤280×109·L-1（1分）,CRP≥60 mg·L-1（1分）,当总分≥3分时敏感度和特异度分别为0.7和0.6。 结论 既往4种评价体系在本文重庆地区研究对象中评价IVIG无反应KD的能效不高,可能并不适于中国儿童。新的评分体系有较高的敏感度,但特异度偏低,预测能效仍不理想。     

IVIG对川崎病冠状动脉病变的预防及治疗作用分析

本文分析了292例川崎病患儿中25例发生冠状动脉病变(CAD)治疗过程中的药物选择、用药时间、用药方法、用药剂量及IVIG治疗冠状动脉病变的作用,提出IVIG是治疗川崎病(KD)预防CAD的首选药物。IVIG使用的最佳剂量为1～2g/kg·次×1次;最佳用药时间为≤7天,当CAD发生时间早、损伤程度轻时,IVIG剂量、时间、疗程适当就可能具有治疗CAD的作用。     

儿童重症腺病毒性肺炎风险模型的构建及静脉注射免疫球蛋白治疗时机的前瞻性研究北大核心CSCD

目的构建儿童重症腺病毒性肺炎(adenoviral pneumonia,AVP)的风险评分模型,并探讨静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG)治疗重症AVP的合适时机。方法回顾性分析1046例AVP患儿的临床资料,运用多因素logistic回归法建立重症AVP风险预测模型。选取102例AVP患儿验证该模型。再前瞻性纳入75例年龄≤14岁且经该模型判定为有可能发展为重症AVP的患儿,按就诊顺序分为A、B、C 3组,每组各25例。A组:仅予对症支持治疗;B组:除对症支持治疗外,在进展为重症AVP前予IVIG治疗,1 g/(kg·d),连续2 d;C组:除对症支持治疗外,在进展为重症AVP后予IVIG治疗,1 g/(kg·d),连续2 d。比较A、B、C 3组治疗后的疗效及相关实验室指标。结果年龄<18.5个月、基础病、热程>6.5 d、血红蛋白<84.5 g/L、谷丙转氨酶>113.5 U/L、合并细菌感染6个变量进入重症AVP风险预测模型。该模型的受试者操作特征曲线下面积为0.862,灵敏度为0.878,特异度为0.848。Hosmer-Lemeshow检验显示模型预测值和实际观测值间的一致性较好(P>0.05)。治疗后,B组发热时间和住院时间最短,住院费用最低,治疗有效率最高,并发症发生率最低,白细胞计数最低,白细胞介素(interleukin,IL)-1、IL-2、IL-6、IL-8、IL-10水平最低,肿瘤坏死因子α水平最高(P<0.05)。结论该研究构建的重症AVP风险模型对预测重症AVP的发生具有良好的价值;在AVP患儿进展为重症前予IVIG治疗效果更好。