川崎病休克综合征临床特征分析
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摘要
目的探讨川崎病休克综合征(KDSS)的临床特点。方法回顾分析2014年6月至2017年10月期间住院诊断为KDSS患儿的临床资料,并以同一时期确诊为川崎病(KD)但血流动力学稳定的患儿作为对照组,分析比较两组患儿的临床特点。结果与119例KD患儿相比,21例KDSS患儿的颈部淋巴结肿大及不完全KD发生率较高,中性粒细胞比例、C反应蛋白、D-二聚体、N末端脑钠肽前体水平较高,血小板及血清白蛋白水平较低,易发生首剂丙种球蛋白无反应及冠状动脉损害,总热程及住院时间较KD患儿明显延长,差异均有统计学意义(P<0.05)。结论 KDSS患儿具有更强烈的炎症反应,存在更明显的高凝状态,易出现丙种球蛋白抵抗。
Objective To explore the clinical characteristics of Kawasaki disease shock syndrome(KDSS). Method The clinical data of hospitalized children diagnosed with KDSS between June 2014 and October 2017 were retrospectively analyzed.The children diagnosed with Kawasaki disease(KD) at the same time with stable hemodynamics were selected as controls. The clinical characteristics of the two groups of children were analyzed and compared. Results Compared with 119 KD children,21 KDSS children had higher percentage of cervical lymph node enlargement and incomplete KD, higher levels of neutrophils,C-reactive protein, D-dimer and N-terminal brain natriuretic peptide precursor, lower platelet count and lower serum albumin level; children with KDSS were more likely to have no response to the first dose of gamma globulin, to suffer from coronary artery damage and to have longer total fever course and hospitalization time than children with KD. The differences were statistically significant(P<0.05). Conclusion Children with KDSS have more intense inflammatory reaction, more obvious hypercoagulability, and are prone to gamma globulin resistance
Objective To explore the clinical characteristics of Kawasaki disease shock syndrome(KDSS). Method The clinical data of hospitalized children diagnosed with KDSS between June 2014 and October 2017 were retrospectively analyzed.The children diagnosed with Kawasaki disease(KD) at the same time with stable hemodynamics were selected as controls. The clinical characteristics of the two groups of children were analyzed and compared. Results Compared with 119 KD children,21 KDSS children had higher percentage of cervical lymph node enlargement and incomplete KD, higher levels of neutrophils,C-reactive protein, D-dimer and N-terminal brain natriuretic peptide precursor, lower platelet count and lower serum albumin level; children with KDSS were more likely to have no response to the first dose of gamma globulin, to suffer from coronary artery damage and to have longer total fever course and hospitalization time than children with KD. The differences were statistically significant(P<0.05). Conclusion Children with KDSS have more intense inflammatory reaction, more obvious hypercoagulability, and are prone to gamma globulin resistance
引文
[1]Wang CL,Wu YT,Liu CA,et al.Kawasaki disease:infection,immunity and genetics[J].Pediatr Infect Dis J,2005,24(11):998-1004.
[2]Huang WC,Huang LM,Chang IS,et al.Epidemiologic features of Kawasaki disease in Taiwan,2003-2006[J].Pediatrics,2009,123(3):e401-e405.
[3]Kato H,Sugimura T,Akagi T,et al.Long-term consequences of Kawasaki disease.A 10-to 21-year follow-up study of 594patients[J].Circulation,1996,94(6):1379-1385.
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[9]Saha A,Khalil S,Kapoor K,et al.Kawasaki shock syndrome presenting as toxic shock syndrome[J].Int J Rheum Dis,2013,16(4):480-482.
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[12]Ma L,Zhang YY,Yu HG.Clinical manifestations of Kawasaki disease shock syndrome[J].Clin Pediatr(Phila),2018,57(4):428-435.
[13]Taddio A,Rossi ED,Monasta L,et al.Describing Kawasaki shock syndrome:results from a retrospective study and literarure review[J].Clin Rheumatol,2017,36(1):223-228.
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[15]Mitani Y,Sawada H,Hayakawa H,et a1.Elevated levels of high-sensitivity C-reactive protein and serum amyloid-A late after Kawasaki disease:association between inflammation and late coronary sequelae in Kawasaki disease[J].Circulation,2005,111(1):38-43.
[16]Ou CY,Tseng YF,Lee CL,et a1.Significant relafionship between serum high-sensitivity C-reactive prorein,highdensity lipoprotein cholesterol levels and children with Kawasaki disease and coronary artery lesions[J].J Formos Med Assoc,2009,108(9):719-724.
[17]Ha KS,Lee J,Jang GY,et al.Value of neut rophil-lymphocyte ratio in predicting outcomes in Kawasaki disease[J].Am JCardlol,2015,116(2):301-306.
[18]Imamura T,Yoshihara T,Yokoi K,et al.Impart of increased D-dimer concentrantions in Kawasaki disease[J].Eur JPediatr,2005,164(8):526-527.
[19]陈树宝.脑利钠肽测定的临床意义[J].中华儿科杂志,2006,44(10):743.
[20]Tremoulet AH,Best BM,Song S,et al.Resistance to intravenous immunoglobulin in children with Kawasaki disease[J].J Pediatr,2008,153(1):117-121.
[21]Saneeymehri S,Baker K,So TY.Overview of pharmacological treatment options for pediatric patients with refractory Kawasaki disease[J].J Pediatr Pharmacol Ther,2015,20(3):163-177.
[22]Burns JC,Capparelli EV,Brown JA,et al.Intravenous gamma-globulin treatment and retreatment in Kawasaki disease,US/Canadian Kawasaki Syndrome Study Group[J].Pediatr Infect Dis J,1998,17(12):1144-1148.
[23]Kobayashi T,Saji T,Otani T,et a1.Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease(RAISE study):a randomised,open-label,blinded-endpoint strial[J].Lancet,2012,379(9826):1613-1620.
[24]Chen S,Dong Y,Yin Y,et al.Intravenous immunoglobulin plus corticosteroids to prevent coronary artery abnormalities in Kawasaki disease:a meta analysis[J].Heart,2013,99(2):76-82.
[2]Huang WC,Huang LM,Chang IS,et al.Epidemiologic features of Kawasaki disease in Taiwan,2003-2006[J].Pediatrics,2009,123(3):e401-e405.
[3]Kato H,Sugimura T,Akagi T,et al.Long-term consequences of Kawasaki disease.A 10-to 21-year follow-up study of 594patients[J].Circulation,1996,94(6):1379-1385.
[4]Yanagawa H,Nakamura Y,Yashiro M,et al.Incidence survey of Kawasaki disease in 1997 and 1998 in Japan[J].Pediatrics,2001,107(3):E33.
[5]Kanegaye JT,Wilder MS,Molkara D,et al.Recognition of a Kawasaki disease shock syndrome[J].Pediatrics,2009,123(5):e783-e789.
[6]Gatterre P,Oualha M,Dupic L,et al.Kawasaki disease:an unexpected etiology of shock and multiple organ dysfunction syndrome[J].Intensive Care Med,2012,38(5):872-878.
[7]Newburger JW,Takahashi M,Gerber MA,et al.Diagnosis,treatment,and long-term management of Kawasaki disease:a statement for health professionals from the Committee on Rheumatic Fever,Endocarditis,and Kawasaki Disease,Council on Cardiovascular Disease in the Young,American Heart Association[J].Pediatrics,2004,114(6):1708-1733.
[8]Lin YJ,Cheng MC,Lo MH,et al.Early differentiation of Kawasaki disease shock syndrome and toxic shock syndrome in a pediatric intensive care unit[J].Pediatr Infect Dis J,2015,34(11):1163-1167.
[9]Saha A,Khalil S,Kapoor K,et al.Kawasaki shock syndrome presenting as toxic shock syndrome[J].Int J Rheum Dis,2013,16(4):480-482.
[10]Gámez-González LB,Murata C,Mu?oz-Ramirez M,et a1.Clinical manifestations associated with Kawasaki disease shock syndrome in Mexican children[J].Eur J Pediatr,2013,172(3):337-342.
[11]Natterer J,Perez MH,Di Bemardo S.Capillary leak leading to shock in Kawasaki disease without myocardial dysfunction[J].Cardiol Young,2012,22(3):349-352.
[12]Ma L,Zhang YY,Yu HG.Clinical manifestations of Kawasaki disease shock syndrome[J].Clin Pediatr(Phila),2018,57(4):428-435.
[13]Taddio A,Rossi ED,Monasta L,et al.Describing Kawasaki shock syndrome:results from a retrospective study and literarure review[J].Clin Rheumatol,2017,36(1):223-228.
[14]仇慧仙,薛超超,陈其,等.川崎病休克综合征的临床特点及危险因素分析[J/CD].中华危重症医学杂志:电子版,2015,8(4):230-234.
[15]Mitani Y,Sawada H,Hayakawa H,et a1.Elevated levels of high-sensitivity C-reactive protein and serum amyloid-A late after Kawasaki disease:association between inflammation and late coronary sequelae in Kawasaki disease[J].Circulation,2005,111(1):38-43.
[16]Ou CY,Tseng YF,Lee CL,et a1.Significant relafionship between serum high-sensitivity C-reactive prorein,highdensity lipoprotein cholesterol levels and children with Kawasaki disease and coronary artery lesions[J].J Formos Med Assoc,2009,108(9):719-724.
[17]Ha KS,Lee J,Jang GY,et al.Value of neut rophil-lymphocyte ratio in predicting outcomes in Kawasaki disease[J].Am JCardlol,2015,116(2):301-306.
[18]Imamura T,Yoshihara T,Yokoi K,et al.Impart of increased D-dimer concentrantions in Kawasaki disease[J].Eur JPediatr,2005,164(8):526-527.
[19]陈树宝.脑利钠肽测定的临床意义[J].中华儿科杂志,2006,44(10):743.
[20]Tremoulet AH,Best BM,Song S,et al.Resistance to intravenous immunoglobulin in children with Kawasaki disease[J].J Pediatr,2008,153(1):117-121.
[21]Saneeymehri S,Baker K,So TY.Overview of pharmacological treatment options for pediatric patients with refractory Kawasaki disease[J].J Pediatr Pharmacol Ther,2015,20(3):163-177.
[22]Burns JC,Capparelli EV,Brown JA,et al.Intravenous gamma-globulin treatment and retreatment in Kawasaki disease,US/Canadian Kawasaki Syndrome Study Group[J].Pediatr Infect Dis J,1998,17(12):1144-1148.
[23]Kobayashi T,Saji T,Otani T,et a1.Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease(RAISE study):a randomised,open-label,blinded-endpoint strial[J].Lancet,2012,379(9826):1613-1620.
[24]Chen S,Dong Y,Yin Y,et al.Intravenous immunoglobulin plus corticosteroids to prevent coronary artery abnormalities in Kawasaki disease:a meta analysis[J].Heart,2013,99(2):76-82.