摘要
目的探讨川崎病（KD）并发冠状动脉病变（CAL）的临床特点;观察大剂量静脉免疫球蛋白（IVIG）治疗对KD患者冠状动脉的影响。方法以中日友好医院儿科收治的57例KD患者为研究对象,根据超声心动图结果分为冠状动脉正常组（NCAL）和CAL组,并对两组临床资料、实验室检查和随访结果进行回顾性分析,应用t检验或χ2检验对NCAL和CAL组资料进行比较。结果 52例KD患者行超声心动图检查,NCAL者32例,CAL者20例,包括冠状动脉扩张（CAD）16例,冠状动脉瘤（CAA）4例。CAL组口腔黏膜病变及肛周皮肤脱屑的发生率低于NCAL组（P〈0.05）;发热时间、白细胞（WBC）、C-反应蛋白（CRP）及天门冬氨酸氨基转移酶（AST）高于NCAL组（P〈0.05）;在CAD患者中,左冠状动脉脉病变的发生率高于右冠状动脉（P〈0.01）。IVIG治疗后6~18 d复查超声心动图,CAD患者左、右冠状动脉直径均明显缩小（P〈0.05）;CAA患者冠状动脉内径变化不明显（P〉0.05）。33例KD患者进行随访,18例NCAL者无新发病变,13例CAD患者冠状动脉直径恢复正常,1例CAA冠状动脉直径增加,1例CAA病变明显减轻。结论热程长、血WBC、CRP及AST升高是KD患者并发CAL的危险因素,而性别、年龄和PLT与CAL无关,大剂量IVIG可促进KD患儿CAL恢复。
Objective To study the clinic features of coronary artery lesion（CAL） in Kawasaki disease（KD）, and observe the changes of coronary artery diameter induced by intravenous immunoglobulin（IVIG） on KD patients. Methods The clinic information, laboratory examination and follow-up results of 57 KD patients were analyzed retrospectively. Results Echocardiography was performed in 52 patients, 30 in non-coronary artery lesion group（NCAL）, 22 in CAL group. In CAL group, the frequency of perianal skin desquamation, and lesions of lips and oral cavity were less than NCAL group（P〈0.05）. The time of fever, the level of white blood cells（WBC）, C-reactive protein（CRP）, and aspartate aminotransferase（AST） in CAL group were significantly higher than NCAL group（P〈0.05）, in patients with coronary artery dilation（CAD）, left coronary artery（LCA） was more susceptive to dilation than right coronary artery（RCA）（P〈0.01）. In CAD patients, the diameter of LCA and RCA were significantly reduced in 6 to 18 days after IVIG treatment（P〈0.05）, while that of CAA patients did not change significantly（P〈0.05）. 33 KD patients were followed up, no new impairment occurred in 18 NCAL cases, the dilated coronary artery in 13 patients with CAD regressed completely, 1 coronary artery aneurysms（CAA） lesion deteriorated, 1 CAA lesions was reduced. Conclusions Long duration of fever, high value of WBC, CRP, and AST are the risk factors of CAL secondary to KD. IVIG is an effective agent in the treatment of KD.
出处
《中华临床医师杂志（电子版）》
CAS
2016年第9期4-7,共4页
Chinese Journal of Clinicians(Electronic Edition)
