广西儿童川崎病特点临床研究
|
摘要
目的探讨川崎病(KD)的发病、流行特征及临床特征。方法回顾性分析2015年7月—2017年6月在广西壮族自治区妇幼保健院223例KD住院患儿的临床资料,分析典型川崎病(CKD)和非典型川崎病(IKD)两组患儿临床特征、实验室检查结果。结果①CKD与IKD在四肢硬肿、脱屑,球结膜充血,口唇皲裂,皮疹,淋巴结肿大的发生率分别为(61.0%vs 22.9%,χ~2=30.89;88.2%vs 32.1%,χ~2=74.68,94.9%vs 39.0%,χ~2=83.92;77.2%vs34.5%,χ~2=40.54;80.8%vs42.5%,χ~2=34.74,P=0.000)。②KD发病率1岁左右最高;3月、5月有两个发病高峰期。③两组在白细胞(WBC)(χ~2=6.942,P=0.008)、中性粒细胞(N)(χ~2=23.474,P=0.000)、C-反应蛋白(CRP)(χ~2=12.82,P=0.000)、CD3+T淋巴细胞(χ~2=8.566,P=0.003)、CD8+T淋巴细胞(χ~2=7.416,P=0.006)、谷丙转氨酶(ALT)(χ~2=7.584,P=0.006)、民族(χ~2=3.944,P=0.047)均差异有统计学意义;④多因素Logistics回归分析显示归分析显示:WBC(OR=0.464,95%CI 0.219～0.980,P<0.05),N(OR=0.319 95%CI 0.138～0.736,P<0.05),与IKD的发生呈负相关。结论汉族儿童典型川崎病的发病率更高;不典型川崎病白细胞、中性粒细胞更低。
Objective To investigate the pathogenesis, epidemiological characteristics and clinical features of Kawasaki disease(KD). Methods The clinical data of 223 children with KD hospitalization in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from July 2015 to June 2017 were retrospectively analyzed. The clinical manifestations of two groups of patients with Kawasaki disease(CKD) and atypical Kawasaki disease(IKD) characteristics, laboratory test results were analyzed. Results 1.The incidence of CKD and IKD in hard limbs, desquamation, conjunctival hyperemia, cleft lip and palate, rash and lymphadenopathy were(61.0% vs 22.9%, χ~2=30.89; 88.2% vs 32.1%,χ~2=74.68; 94.9% vs 39.0%,χ~2=83.92; 77.2% vs 34.5%,χ~2=40.54; 80.8% vs 42.5%, χ~2=34.74, P=0.000).2.KD incidence was highest about 1 year old;Two peak incidences in March and May. 3.Two groups in white blood cells(WBC)(χ~2=6.942,P=0.008), neutrophils(N)(χ~2=23.474, P=0.000), C-reactive protein(CRP)(χ~2=12.82, P=0.000), CD3+ T lymphocytes(χ~2=8.566,P=0.003), CD8+ T lymphocytes(χ~2=7.416 P=0.006), alanine aminotransferase(ALT)(χ~2=7.584,P=0.006), ethnic differences(χ~2=3.944,P=0.047),the difference was statistically significant; 4.Multivariate logistic regression analysis showed that the analysis showed: WBC(OR=0.464, 95%; CI 0.219-0.980, P<0.05), N(OR=0.319, 95% CI 0.138-0.736, P<0.05), which was negatively correlated with the occurrence of IKD. Conclusion The incidence of Kawasaki disease is higher in Han ethnic; atypical Kawasaki disease has lower white blood cells and neutrophils.
Objective To investigate the pathogenesis, epidemiological characteristics and clinical features of Kawasaki disease(KD). Methods The clinical data of 223 children with KD hospitalization in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from July 2015 to June 2017 were retrospectively analyzed. The clinical manifestations of two groups of patients with Kawasaki disease(CKD) and atypical Kawasaki disease(IKD) characteristics, laboratory test results were analyzed. Results 1.The incidence of CKD and IKD in hard limbs, desquamation, conjunctival hyperemia, cleft lip and palate, rash and lymphadenopathy were(61.0% vs 22.9%, χ~2=30.89; 88.2% vs 32.1%,χ~2=74.68; 94.9% vs 39.0%,χ~2=83.92; 77.2% vs 34.5%,χ~2=40.54; 80.8% vs 42.5%, χ~2=34.74, P=0.000).2.KD incidence was highest about 1 year old;Two peak incidences in March and May. 3.Two groups in white blood cells(WBC)(χ~2=6.942,P=0.008), neutrophils(N)(χ~2=23.474, P=0.000), C-reactive protein(CRP)(χ~2=12.82, P=0.000), CD3+ T lymphocytes(χ~2=8.566,P=0.003), CD8+ T lymphocytes(χ~2=7.416 P=0.006), alanine aminotransferase(ALT)(χ~2=7.584,P=0.006), ethnic differences(χ~2=3.944,P=0.047),the difference was statistically significant; 4.Multivariate logistic regression analysis showed that the analysis showed: WBC(OR=0.464, 95%; CI 0.219-0.980, P<0.05), N(OR=0.319, 95% CI 0.138-0.736, P<0.05), which was negatively correlated with the occurrence of IKD. Conclusion The incidence of Kawasaki disease is higher in Han ethnic; atypical Kawasaki disease has lower white blood cells and neutrophils.
引文
[1]Kontopoulou T,Kontopoulos DG,Vaidakis E,et al.Adult Kawasaki disease in a European patient:a case report and review of the literature[J].J Med Case Rep,2015,9(1):75.
[2]Chen JJ,Ma XJ,Liu F,et al.Epidemiologic Features of Kawasaki Disease in Shanghai From 2008 Through 2012[J].Pediatr Infect Dis J,2016,35(1):7-12.
[3]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].Circulation,2004,110(17):2747-2771.
[4]Nakamura Y.Kawasaki disease:epidemiology and the lessons from it[J].Int J Rheum Dis,2018,21(1):16-19.
[5]Tsai HC,Chang LY,Lu CY,et al.Transmission of acute infectious illness among cases of Kawasaki disease and their household members[J].J Fonnos Med Assoc,2015,114(1):72-76.
[6]郭敏,陈翊,肖密丝,等.2013-2014年广州地区住院儿童急性呼吸道感染病毒病原学及临床特点分析[J].中华生物医学工程杂志,2016,12(6):476-481.
[7]阮瑜,赵晓东.川崎病并发症临床分析[J].中华实用儿科临床杂志,2014,29(1):37-40.
[8]Tacke CE,Breunis WB,Pereira RR,et al.Five years of Kaw asaki disease in the Netherlands:a national surveillance study[J].Pediatr Infect Dis J,2014,33(8):793-797.
[9]Bai L,Feng T,Yang L,et al.Retrospective analysis of risk factors associated with Kawasaki disease in China[J].Oncotarget,2017,8(33):54357-54363.
[10]Chen J,Li JH,Zhao SJ,et al.Clinical significance of costimulatory molecules CD40/CD40L and CD134/CD134Lin coronary heart disease:A case-control study[J].Medicine(Baltimore),2017,96(32):e7634.
[11]Jiang C,Fang X,Jiang Y,et al.TNF-αinduces vascular endothelial cells apoptosis through overexpressing pregnancy induced noncoding RNA in Kawasaki disease model[J].Int J Biochem Cell Biol,2016,72:118-124.
[12]Maric LS,Knezovic I,Papic N,et al.Risk factors for coronary artery abnormalities in children with Kawasaki disease:a 10-year experience[J].Rheumatol Int,2015,35(6):1053-1058.
[13]彭丽珠,李彩环,李军黎.川崎病合并肝损害的特点及相关因素分析[J].中国医学创新,2015(21):121-122.
[2]Chen JJ,Ma XJ,Liu F,et al.Epidemiologic Features of Kawasaki Disease in Shanghai From 2008 Through 2012[J].Pediatr Infect Dis J,2016,35(1):7-12.
[3]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].Circulation,2004,110(17):2747-2771.
[4]Nakamura Y.Kawasaki disease:epidemiology and the lessons from it[J].Int J Rheum Dis,2018,21(1):16-19.
[5]Tsai HC,Chang LY,Lu CY,et al.Transmission of acute infectious illness among cases of Kawasaki disease and their household members[J].J Fonnos Med Assoc,2015,114(1):72-76.
[6]郭敏,陈翊,肖密丝,等.2013-2014年广州地区住院儿童急性呼吸道感染病毒病原学及临床特点分析[J].中华生物医学工程杂志,2016,12(6):476-481.
[7]阮瑜,赵晓东.川崎病并发症临床分析[J].中华实用儿科临床杂志,2014,29(1):37-40.
[8]Tacke CE,Breunis WB,Pereira RR,et al.Five years of Kaw asaki disease in the Netherlands:a national surveillance study[J].Pediatr Infect Dis J,2014,33(8):793-797.
[9]Bai L,Feng T,Yang L,et al.Retrospective analysis of risk factors associated with Kawasaki disease in China[J].Oncotarget,2017,8(33):54357-54363.
[10]Chen J,Li JH,Zhao SJ,et al.Clinical significance of costimulatory molecules CD40/CD40L and CD134/CD134Lin coronary heart disease:A case-control study[J].Medicine(Baltimore),2017,96(32):e7634.
[11]Jiang C,Fang X,Jiang Y,et al.TNF-αinduces vascular endothelial cells apoptosis through overexpressing pregnancy induced noncoding RNA in Kawasaki disease model[J].Int J Biochem Cell Biol,2016,72:118-124.
[12]Maric LS,Knezovic I,Papic N,et al.Risk factors for coronary artery abnormalities in children with Kawasaki disease:a 10-year experience[J].Rheumatol Int,2015,35(6):1053-1058.
[13]彭丽珠,李彩环,李军黎.川崎病合并肝损害的特点及相关因素分析[J].中国医学创新,2015(21):121-122.