儿童大动脉炎35例临床分析

目的:探讨儿童大动脉炎的临床特点,提高对该病的认识。方法:研究对象为1990年1月～2008年1月在吉林大学第一医院儿科住院并确诊为儿童多发性大动脉炎的患儿共35例,对其城乡分布、临床表现、病情活动性指标以及病情严重性等进行回顾性分析并与文献报道过的成人多发性大动脉炎进行比较。结果:35例患儿中男18例,女17例,发病年龄4～15岁,平均为(11.5±2.2)岁,确诊时病程7天～48个月,其中位数时间为2个月。临床分型以Ⅱ型为最多占57.1%,首发症状以头痛(51.4%)、抽搐(37.1%)等较为多见;在体征方面高血压94.3%、血管杂音61.4%、无脉或脉弱74.1%,共有22例患儿心脏受累所占的比例约为62.8%;仅有不到一半的患儿出现炎性指标升高,就诊时共有30例患儿处于病情活动期占85.7%,有94%以上的患儿出现一种或一种以上的并发症。结论:与文献报道中的成人发病情况比较,儿童多发性大动脉炎并非少见而且较成人大动脉炎起病急、病情重、预后差,在临床工作中应注意监测血压,以减少漏诊及误诊的几率。

Clinical analysis of 35 cases with Takayasu's arteritis in children

Objective:To investigate the clinical characteristics of Takayasus arteritis children.Methods:Thirty-five pediatric patients with Takayasu's arteritis admitted into our hospital from 1990 to 2008 were retrospectively evaluated for location,the clinical features.Results:There were eighteen male cases,seventeen female cases in 35 patients with Takayasu's arteritis,and the ratio of male to female was 1:0.9.The onset age was from 4 to 15 years(average 11.5±2.2 years).The duration of diagnosis was from 7 days to 48 months,and the median was 2 months.The distribution of village and town/city was 2:1.The misdiagnosis rate was 80%,Type Ⅱ was the most clinical classification,accounting for about 57.1%.The common first symptoms were headache(51.4%),convulsion(37.1%),and the common signs were high blood pressure(94.3%),vascular murmur(61.4%),pulselessness or weak pulse(74.1%).A total of 22 cases of children had cardiac involvement,accounting for about 62.8%.Markers of inflammation increased in only less than half of children;30 cases of children were at the active phase,accounting for 85.7%;More than 94% of patients had one or more complications,and 94.3% of patients had high blood pressure,compared with the adult patients reported before.Conclusion:Compared with the adult,Children Takayasu arteritis is not uncommon and have acuter onset,worse condition and prognosis.In clinical work,we should pay more attention to monitoring blood pressure,in order to reduce the risk of missed diagnosis and misdiagnosis.