川崎病合并肝损害的特点及相关因素分析

目的研究川崎病合并肝损害的特点,探讨可能的相关因素,提高对川崎病合并肝损害的认识。方法收集2008-2013年收治的75例川崎病患儿的临床资料,回顾性分析肝损害的临床特点及血常规、C反应蛋白(CRP)、血沉、肝功能检查、腹部B超等相关指标。计数资料采用χ2检验,计量资料组间差异采用t检验分析、多元逐步回归分析。结果 75例川崎病患儿ALT异常发生率32%,79.2%患儿血清ALT升高在200 IU/L以内,其中伴肝肿大的患儿3例,黄疸、脾大患儿各1例,分别占肝损害患儿的12.5%、4.2%和4.2%。在肝损害的相关因素分析中未发现CRP、血沉与肝损害有相关关系(t=1.560、1.291,P=0.123、0.201)。血小板在肝损害的研究中,与对照组差异有统计学意义(t=-3.228,P=0.003)。白细胞计数升高在肝损害组与对照组之间差异不明显,但是与血小板同时升高时肝损害几率明显升高(P0.05)。结论未发现CRP、血沉与肝损害的发生有明显相关关系,但是血小板的异常与肝损害的发生关系密切,白细胞计数也与肝损害的发生存在一定联系,应引起临床医生注意,及早干预。

Clinical features and related factors for Kawasaki disease with liver damage

Objective To study the features of Kawasaki disease （KD） with liver damage and investigate the possible related factors, and to improve the understanding of liver damage in KD patients. Methods The clinical data of 75 KD patients admitted from 2008 to 2013 were collected to retrospectively analyze the clinical features of liver damage, as well as routine blood test, C -reactive protein （CRP）, erythroeyte sedimentation rate （ESR）, liver function, and abdominal ultrasound. Categorical data were analyzed by chi - square test; continuous data were expressed as mean ±standard deviation ; comparison between groups was made by t test and multivariate stepwise regression analysis. Results The incidence of abnormal alanine aminotransferase （ALT） level in 75 cases was 32% , and 79.2% of these patients had a serum ALT level of less than 200 IU/L, including 3 patients with hepatomegaly, 1 patient with jaundice, and 1 patient with splenomegaly, which accounted for 12.5% , 4.2% , and 4.2% , respectively, of patients with liver damage. CRP and ESR were not found to be related to liver damage （ t = 1. 560, P = 0. 123 ; t = 1. 291, P = 0. 201 ）. There was significant difference in platelet count between patients with liver damage and controls （ t = - 3. 228, P = 0. 003 ）. No significant difference in white blood cell （WBC） count increase was found between the liver damage group and control group, but simultaneous increase in WBC count and platelet count was significantly associated with an increased risk of liver damage （ P 〈 0.05 ）. Conclusion CRP and ESR are not found to be significantly related to the development of liver damage, but there is a close relationship between liver damage and abnormal platelet count. WBC count shows a certain relationship with liver damage. Clinicians should pay attention to these factors and take timely measures for intervention.