417例川崎病患儿单中心回顾性研究
|
摘要
目的:总结川崎病(KD)患儿的临床资料,分析其临床特点及变化趋势。方法:对2011-2016年在荆州市中心医院确诊的417例KD住院患儿的临床资料进行回顾性分析,按照入院时间分为三组:A组(2011-2012年) 70例,B组(2013-2014年)139例,C组(2015-2016年) 208例,比较三组KD患儿的临床特点及变化情况。结果:KD患儿的入院构成比从2011年的3.18/10 000上升至2016年7.86/10 000,呈逐年上升的趋势(P<0.05)。0～1岁组49例(11.8%),>1～2组岁173例(41.6%),>2～5岁组170例(40.7%),>5～14岁组25例(5.9%)。冠状动脉损害(CAL)发生率31.2%。不完全KD(IKD)早期易诊断为急性化脓性淋巴结炎、脓毒症、呼吸道感染等导致KD延迟诊断。IVIG耐受组KD应用糖皮质激素(GC)治疗可较快退热,缓解病情。结论:2011-2016年荆州市中心医院KD患儿的入院构成比呈逐渐增高的趋势,1～5岁为高发年龄,CAL发生率明显增高,IKD早期易误诊为其他疾病。GC对IVIG耐受KD患儿治疗有效。
Objective:To summarize the clinical data of children with Kawasaki disease(KD) and to analyze the clinical characteristics and changes of trends.Methods:The clinical data of 417 KD hospitalized children diagnosed in Jingzhou Central Hospital from 2011 to2016 were retrospectively analyzed and divided into three groups according to the admission time:70 cases in group A(from 2011 to2012),139 cases in group B(from 2013 to 2014) and 208 cases in group C(from 2015 to 2016).Clinical characteristics and changes of three groups were compared.Results:The proportion of children with KD admitted into hospital increased from 3.18/10,000 in 2011 to 7.86/10,000 in 2016,showing a gradually increasing trend(P<0.05).There were 49 cases(11.8%) in the group aged from 0 to 1 years old,173 cases(41.6%) in the group aged from 1 to 2 years old,170 cases(40.7%) in the group aged from 2 to 5 years old,and25 cases(5.9%) in the group aged from 5 to 14 years old.The incidence of coronary damage(CAL) was 31.2%.Incomplete KD(IKD) was easy to be diagnosed as acute suppurative lymphadenitis,sepsis and respiratory tract infection at an early stage,which could lead to delayed diagnosis of KD.In the IVIG tolerant group,KD treatment with glucocorticoid(GC) can rapidly reduce fever and relieve the disease.Conclusion:In the past 6 years,the proportion of children with KD admitted into Jingzhou Central Hospital has been in an increasing trend.The incidence of CAL is significantly increased in the age of 1 to 5 years old.The early stage of IKD is easily misdiagnosed as other diseases.GC is effective in the treatment of children with KD in the IVIG tolerant group.
Objective:To summarize the clinical data of children with Kawasaki disease(KD) and to analyze the clinical characteristics and changes of trends.Methods:The clinical data of 417 KD hospitalized children diagnosed in Jingzhou Central Hospital from 2011 to2016 were retrospectively analyzed and divided into three groups according to the admission time:70 cases in group A(from 2011 to2012),139 cases in group B(from 2013 to 2014) and 208 cases in group C(from 2015 to 2016).Clinical characteristics and changes of three groups were compared.Results:The proportion of children with KD admitted into hospital increased from 3.18/10,000 in 2011 to 7.86/10,000 in 2016,showing a gradually increasing trend(P<0.05).There were 49 cases(11.8%) in the group aged from 0 to 1 years old,173 cases(41.6%) in the group aged from 1 to 2 years old,170 cases(40.7%) in the group aged from 2 to 5 years old,and25 cases(5.9%) in the group aged from 5 to 14 years old.The incidence of coronary damage(CAL) was 31.2%.Incomplete KD(IKD) was easy to be diagnosed as acute suppurative lymphadenitis,sepsis and respiratory tract infection at an early stage,which could lead to delayed diagnosis of KD.In the IVIG tolerant group,KD treatment with glucocorticoid(GC) can rapidly reduce fever and relieve the disease.Conclusion:In the past 6 years,the proportion of children with KD admitted into Jingzhou Central Hospital has been in an increasing trend.The incidence of CAL is significantly increased in the age of 1 to 5 years old.The early stage of IKD is easily misdiagnosed as other diseases.GC is effective in the treatment of children with KD in the IVIG tolerant group.
引文
[1]JUN J S,JUNG Y K,LEE D W.Relationship between vitamin Dlevels and intravenous immunoglobulin resistance in Kawasaki disease[J].Korean J Pediatr,2017,60(7):216-220.
[2]江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社,2015:778-786.
[3]EBBESON R L,RILEY M R,POTTS J E,et al.Kawasaki disease at British Columbia’s Children’s Hospital[J].Paediatr Child Health,2004,9(7):466-470.
[4]付培培,杜忠东,潘岳松.2002-2010年北京儿童医院川崎病住院患儿临床分析[J].实用儿科临床杂志,2012,27(9):661-664.
[5]黄国英,马晓静,黄敏.上海地区1998-2002年川崎病流行病学特征[J].中国循证儿科杂志,2006,1(1):8-13.
[6]MAKINO N,NAKAMURA Y,YASHIRO M,et al.Descriptive epidemiology of Kawasaki disease in Japan,2011-2012:From the results of the 22nd nationwide survey[J].J Epidemiol,2015,25(3):239-245.
[7]CHEN J J,MA X J,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.
[8]BAER A Z,RUBIN L G,SHAPIRO C A,et al.Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome[J].Arch Pediatr Adolesc Med,2006,160(7):686-690.
[9]SHAH V,CHRISTOV G,MUKASA T,et al.Cardiovascular status after Kawasaki disease in the UK[J].Heart,2015,101(20):1646-1655.
[10]张丹凤,钟家蓉,王丹.完全川崎病和不完全川崎病冠脉病变对比研究[J].临床儿科杂志,2018,36(1):14-18.
[11]段泓宇,胡梵,王晓琴.川崎病冠状动脉损害危险因素的分析[J].西部医学,2009,21(5):727-729.
[12]陈颖,曾嵘.甲基泼尼松治疗静脉丙种球蛋白无反应型川崎病的疗效观察[J].儿科药学杂志,2016,22(8):17-19.
[13]LI J,WANG B L,FENG R B,et al.Efficacy of glucocorticoids combined with immunoglobulin in initial treatment of Kawasaki disease:A meta analysis[J].Chinese journal of contemporary pediatrics,2016,18(6):527-533.
[14]HU J W,ZHOU Z S,YANG L,et al.Efficacy and safety of glucocorticoids in addition to intravenous immunoglobulin in the initial treatment of Kawasaki disease:A meta-analysis of randomized trials[J].National Medical Journal of China,2011,91(18):1259-1264.
[15]HU P,JIANG G M,WU Y,et al.TNF-αis superior to conventional inflammatory mediators in forecasting IVIGnonresponse and coronary arteritis in Chinese children with Kawasaki disease[J].Clin Chim Acta,2017,471:76-80.
[16]KOREMATSU S,OHTA Y,TAMAI N,et al.Cell distribution differences of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in patients with Kawasaki disease[J].Pediatr Infect Dis J,2012,31(9):973-984.
[17]谢利剑,徐萌,黄敏,等.547例川崎病临床分析及伴冠脉病变高危因素探讨[J].临床儿科杂志,2008,26(5):389-391.
[18]SONG G,REN W,LIU Z,et al.Incomplete Kawasaki disease with coronary artery aneurysm and coronary sinus thrombus[J].Pediatr Cardiol,2015,36(5):1097-1099.
[19]DOWNIE M L,MANLHIOT C,COLLINS T H,et al.Factors associated with development of coronary artery aneurysms after Kawasaki disease are similar for those treated promptly and those with delayed or no treatment[J].Int J Cardiol,2017,236:157-161.
[2]江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社,2015:778-786.
[3]EBBESON R L,RILEY M R,POTTS J E,et al.Kawasaki disease at British Columbia’s Children’s Hospital[J].Paediatr Child Health,2004,9(7):466-470.
[4]付培培,杜忠东,潘岳松.2002-2010年北京儿童医院川崎病住院患儿临床分析[J].实用儿科临床杂志,2012,27(9):661-664.
[5]黄国英,马晓静,黄敏.上海地区1998-2002年川崎病流行病学特征[J].中国循证儿科杂志,2006,1(1):8-13.
[6]MAKINO N,NAKAMURA Y,YASHIRO M,et al.Descriptive epidemiology of Kawasaki disease in Japan,2011-2012:From the results of the 22nd nationwide survey[J].J Epidemiol,2015,25(3):239-245.
[7]CHEN J J,MA X J,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.
[8]BAER A Z,RUBIN L G,SHAPIRO C A,et al.Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome[J].Arch Pediatr Adolesc Med,2006,160(7):686-690.
[9]SHAH V,CHRISTOV G,MUKASA T,et al.Cardiovascular status after Kawasaki disease in the UK[J].Heart,2015,101(20):1646-1655.
[10]张丹凤,钟家蓉,王丹.完全川崎病和不完全川崎病冠脉病变对比研究[J].临床儿科杂志,2018,36(1):14-18.
[11]段泓宇,胡梵,王晓琴.川崎病冠状动脉损害危险因素的分析[J].西部医学,2009,21(5):727-729.
[12]陈颖,曾嵘.甲基泼尼松治疗静脉丙种球蛋白无反应型川崎病的疗效观察[J].儿科药学杂志,2016,22(8):17-19.
[13]LI J,WANG B L,FENG R B,et al.Efficacy of glucocorticoids combined with immunoglobulin in initial treatment of Kawasaki disease:A meta analysis[J].Chinese journal of contemporary pediatrics,2016,18(6):527-533.
[14]HU J W,ZHOU Z S,YANG L,et al.Efficacy and safety of glucocorticoids in addition to intravenous immunoglobulin in the initial treatment of Kawasaki disease:A meta-analysis of randomized trials[J].National Medical Journal of China,2011,91(18):1259-1264.
[15]HU P,JIANG G M,WU Y,et al.TNF-αis superior to conventional inflammatory mediators in forecasting IVIGnonresponse and coronary arteritis in Chinese children with Kawasaki disease[J].Clin Chim Acta,2017,471:76-80.
[16]KOREMATSU S,OHTA Y,TAMAI N,et al.Cell distribution differences of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in patients with Kawasaki disease[J].Pediatr Infect Dis J,2012,31(9):973-984.
[17]谢利剑,徐萌,黄敏,等.547例川崎病临床分析及伴冠脉病变高危因素探讨[J].临床儿科杂志,2008,26(5):389-391.
[18]SONG G,REN W,LIU Z,et al.Incomplete Kawasaki disease with coronary artery aneurysm and coronary sinus thrombus[J].Pediatr Cardiol,2015,36(5):1097-1099.
[19]DOWNIE M L,MANLHIOT C,COLLINS T H,et al.Factors associated with development of coronary artery aneurysms after Kawasaki disease are similar for those treated promptly and those with delayed or no treatment[J].Int J Cardiol,2017,236:157-161.