川崎病并冠状动脉损害的危险因素

目的探讨川崎病(KD)并冠状动脉损害(CAL)的危险因素。方法收集1999年1月-2001年12月住院的145例KD患儿的临床资料,分析无CAL93例和CAL52例患儿的实验室检查资料及治疗、随访结果。结果无CAL组发热日程(8.7±3.4)d.血沉(79.5±34.6)mm/1h,CAL组发热日程(11.5±4.8)d,血沉(91.9±36.6)mm/1h,两组比较差异有显著性(P<0.01,0.05)。发病10d内接受静脉注射人血丙种球蛋白(IVIG)治疗患儿CAL发生率为18.8%(18/96),未予IVIG治疗患儿CAL发生率为69.4%(34/49),两者比较差异有显著性(P<0.001)。随访并CAL患儿38例,冠状动脉扩张20例均恢复正常;14例冠状动脉瘤中12例恢复正常,2例缩小;4例巨大冠状动脉瘤2例缩小,另2例超过2年仍未恢复。结论KD并CAL与热程过长及血沉显著增快密切相关,病程早期未予IVIG治疗的患儿并CAL的危险性明显增高,应用IVIG治疗对防治冠状动脉损害有重要作用。

Analysis of Risk Factors on Coronary Artery Lesions Secondary to Kawasaki Disease

Objective To investigate the risk factors on children with coronary artery lesions (CAL) secondary to Kawasaki di-sease(KD). Methods One hundred and forty - five patients with KD from January 1999 to December 2001 were collected. Among them, 93 cases without CAL and 52 cases with CAL. The test results, therapeutic methods and prognosis were analyzed in two groups. Results The duration of fever was longer and mean value of erythrocyte sedimentation rate (ESR) higher in group with CAL than those m the group without CAL(P0.05).The incidence of CAL was 18.8% (18/96) in patients of IVIG treatment within 10 days from onset, and 69.4% (34/49) in patients without IVIG treatment (P<0.001). CAL was observed by echocardiograthy in 38 patients, of them 20 cases with coronary artery dilatation recovered; Among 14 cases with coronary artery aneurysm, 12 cases recovered, 2 cases improved; In 4 cases with giant coronary artery aneurysm, 2 cases improved, 2 cases rebounded difficultly. Conclusions Long time of fever and higher ESR are closely associated with CAL secondary to KD. The risk of CAL is higher in the patients without IVIG treatment in the early stage of the disease, IVIG treatment playes an important role in the prevention of CAL.