大年龄组与低年龄组儿童川崎病临床特点的比较研究

目的]对大年龄组（5岁以上）和低年龄组儿童（5岁以下）川崎病（kawasaki disease,KD）患儿的临床特点进行比较分析,以进一步提高对大年龄组儿童KD临床表现的认识。方法]对2004年1月至2011年5月在浙江省台州地区诊治的KD患儿资料进行回顾性分析和总结。结果]158例KD患儿中低年龄组共119例（75.3%）,大年龄组共39例（24.7%）。研究发现,大年龄组儿童较低年龄组儿童皮疹发生率低（P〈0.01）;在使用丙种球蛋白前后,大年龄组儿童发热持续时间均较低年龄组儿童长,且冠状动脉病变及不完全KD的发生率较高。但两组之间丙种球蛋白治疗有效性、结膜充血、手足硬肿、淋巴结肿大、脱皮等发生率无统计学差异（P〉0.05）。实验室检查发现大年龄组比低年龄组的血沉、血红蛋白及白细胞明显升高（P〈0.05）,并且与低年龄组比较,大年龄组急性期有炎症因子的高表达。结论]大年龄组儿童不完全KD和冠状动脉病变发生率均较高,其较高的冠状动脉病变发生率可能与剧烈的炎症反应有关。

A Comparison of the Clinical Characteristics of Kawasaki Disease in Children from Taizhou

Objectives] To evaluate characteristics of Kawasaki disease（KD） in children younger than 5 years old in comparison with older than 5 years old, and to improve the knowledge of clinicians on KD in older children. Method] The clinical characteristics and tre~Ltment of Kawasaki disease from January, 2004 to May,2011 were analyzed retrospectively and summarized. Results] A total of 158 patients were included irL this study, 39 patients（24.7%） were ≥ 5 years old and 79 patients（75.3%） were 〈5 years old. The older children seemed to have longer total fever duration, pre-intravenous irnmunoglobulin（IVIG） and post-IVIG fever duration and higher coronary artery disease（23.08% vs.8.40%） than the younger children, and the incidence rate of incomplete KD was higher in younger infant. But there was no difference in effect of IVIG,incidence of conjunctival hyperemia, extremity hardness, cervical lymphadenopathy and rash, etc（P〉0.05）. There was statistical difference in erythrocyte sedimentation rate（ESR）, hemoglobin（Hb） and white blood cell（WBC） count between 2 groups（P 〈0.05）.The expression of infammafion factor in acute phase of older children was higher than the younger children（P〈0.05）. Conclusions] Older patients had a higher prevalence of KD and coronary artery abnormalities than the younger patients. The occurrence of coronary artery might be related to more marked inflammatory response.