儿童再发川崎病77例临床特征回顾性分析

目的 探讨再发川崎病(KD)的临床特点及其预后。方法 收集1994年1月至2012年10月重庆医科大学附属儿童医院收治的KD再发病例，比较初发时和复发时的临床特征、实验室指标和随访资料。并选取5～10年未再发KD病例作为对照组，探讨KD再发可能的危险因素。结果 19年间收治KD 4 875例，其中再发KD 77例，再发1次74例，再发2次3例,男∶女为1.4∶1。再发平均间隔时间1.6年，1年以内再发45.4%（35/77）。发热病程再发时较初发时缩短 (7.6±3.1) vs ( 8.9 ± 3.8) d，P＜0.05；WBC和CRP水平再发时较初发时显著降低，(14.3±5.7) vs (16.2 ±5.4)×109·L-1和(61±58) vs ( 95±76) mg·L-1，P均<0.05。急性期（病程≤30 d）冠状动脉病变（CAL ）发生率初发时为17.8%（13/73) ，再发时为13.3%( 10/75)；应用IVIG后亚急性期（病程>30 d）CAL发生率初发时为11.0%（8/73),再发时为9.3%（7/75)，组间比较差异均无统计学意义。7例初发时与再发时均有CAL，其中1例初发时与再发时均合并冠状动脉瘤（CAA）。52例KD再发患儿有出院后随访资料，随访时间平均2.1年，其中1 例再发时合并左侧冠状动脉主干小型CAA的患儿随访中出现新发部位左前降支瘤样扩张，冠状动脉内径回缩至正常后4年7个月再次出现左侧冠状动脉扩张。多因素Logistic分析显示，年龄＜3岁、性别、热程＞10 d、并发CAL及WBC>20×109·L-1均与KD再发无统计学关联。结论 KD再发多发生在1年内。再发KD的CAL总发生率并未升高，初发时合并CAL患儿，再发时更易发生CAL。

Retrospective analysis of clinical characteristics of 77 recurrent Kawasaki disease cases in children

Objective To investigate the clinical features, prognosis and prognostic factors of recurrent Kawasaki disease (KD). Methods The clinical data of 77 children with recurrent KD admitted to Children's Hospital of Chongqing Medical University from Jan. 1994 to Oct. 2012 were retrospectively studied and compared with their initial onset．Long-term followed-up was completed for children with recurrent KD. 77 KD patients hospitalized in 2001-2007 and without recurrence of KD in 5 years after treatment were selected randomly as case-control group, and potential risk factors for recurrence were analyzed. Results KD relapsed 2 months to 7 years (average 1.6 years) after the first onset in the 77 children. Compared with the initial KD onset , the clinical symptoms were less severe and the total fever duration was remarkably shorter in the recurrent KD patients［(7.6±3.1) d vs (8.9 ± 3.8) d，P＜0.05］. The levels of WBC and CRP were remarkably lower in the recurrent KD group(P＜0.05). The incidence of CAL did not increase compared with the initial KD group (13.3% vs 17.8%，P＞0.05) in the acute stage. 7 cases were detected CALs at first onset and recurrence, including 1 case with CAA in initial onset and recurrence. 52 out of 77 recurrent cases with recurrent KD were effectively followed up for 6 months to 6 years and 5 months. 1 case of recurrence with small CAA appeared coronary artery dilatation at different location during the follow-up, with recurrent coronary artery dilating after 4 years and 7 months. Multiple Logistic regression analysis showed that age<3 years,sex, fever duration>10 d, CAL、white blood cell counts >20.00×109·L-1 weren't the independent risk factors of KD recurrence. Conclusion The interval between the two episodes of KD recurrence is mostly within 1 year. Recurrent KD may be not associated with an increased incidence of CAL. Coronary artery dilation may occur in a new part or relapse after retraction in the acute stage.