2002-2010年北京儿童医院川崎病住院患儿临床分析

目的总结川崎病的临床特征,以指导临床治疗。方法回顾性分析2002年1月-2010年12月1 484例北京儿童医院川崎病住院患儿临床资料,总结分析其临床特征。结果北京儿童医院川崎病患儿年龄分布为2个月～14.7岁,高峰年龄为1岁;男女=1.821,复发率1.7%。6种主要临床表现中,发热为最常见临床表现,皮疹发生率最低。1 484例川崎病患儿中行2 g.kg-1IVIG初次治疗者占92.4%,其中IVIG无反应型川崎病发生率为16.9%。实验室检查中CRP升高、ESR升高、白细胞升高、贫血、血浆清蛋白降低、低钠血症、肝功能异常、心肌酶异常发生率分别为94.5%、96.4%、89.2%、72.3%、81.8%、37.9%、56.9%、27.4%。其中贫血及心肌酶升高婴幼儿发生率较高,且除贫血和肝功能异常外,其他化验指标在冠状动脉扩张发生率方面无统计学差异。冠状动脉扩张发生率为36.1%,非冠状动脉心血管并发症中,心电图异常最常见,发生率为32.3%。结论本组90%以上的川崎病患儿CRP及ESR升高,提示CRP及ESR可作为川崎病尤其是不完全川崎病的参考诊断指标,除贫血和肝功能异常外其他化验指标在冠状动脉扩张发生率方面无统计学差异,提示这2项指标在一定程度上可反映病情的轻重。

Clinical Analysis of Kawasaki Disease in Children in Beijing Children's Hospital from 2002 to 2010

Objective To summarize clinical feature of Kawasaki disease and guide clinical treatment.Methods Retrospect 1 484 cases of Kawasaki disease from Jan.2002 to Dec.2010 in Beijing Children′s Hospital and summarize and analyze the clinical features.Results Their age varied from 2 months to 14.7 years with the peak age of 1 year old.The male to female ratio was 1.821 and the recurrence rate was 1.7%.Febrile was the most common clinical feature,and pleomorphism rash was the most rare clinical feature.Ninety-two point four percent of patients were treated by intravenous immunoglobulin 2 g·kg-1 once with refractory Kawasaki disease incidence rate of 16.9%.The incidence rate of C-reactive protein(CRP) increase,erythrocyte sedimentation rate increase,white blood cell increase,anemia,albumin decrease,hyponatremia,abnormal liver function and abnormal myocardial enzyme were 94.5%,96.4%,89.2%,72.3%,81.8%,37.9%,56.9%and 27.4%,respectively.Anemia and abnormal myocardial enzyme happened more often in infant,and there was no significant difference between normal and abnormal assay index at the rate of coronary dilation,except for anemia and abnormal liver function.The rate of coronary dilation was 36.1%,with incidence rate of abnormal electrocardiogram of 32.3%.Conclusions The rise of CRP and ESR can be a good indicator of Kawasaki disease especially of incomplete Kawasaki disease,their incidence rates were both higher than 90% in Kawasaki disease patients.To some extent,anemia and abnormal liver function can reflect the seriousness of the illness,because the rate of coronary dilation is higher in patients with anemia or abnormal liver function than that in patients with normal Kawasaki disease.