吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (04): 820-824.doi: 10.13481/j.1671-587x.20180424

• 临床医学 • 上一篇    下一篇

川崎病伴有关节受累患儿的临床特征分析

张胜, 朴金花, 梁雪   

  1. 吉林大学第一医院小儿心血管科, 吉林 长春 130021
  • 收稿日期:2018-03-22 出版日期:2018-07-28 发布日期:2018-07-27
  • 通讯作者: 朴金花,教授,硕士研究生导师(Tel:0431-88782558,E-mail:jinhua_piao@hotmail.com) E-mail:jinhua_piao@hotmail.com
  • 作者简介:张胜(1990-),女,吉林省长春市人,住院医师,在读医学硕士,主要从事小儿心血管疾病诊治方面的研究。
  • 基金资助:
    吉林省发改委产业技术研究与开发专项项目资助课题(吉发改高技[2013]779号)

Analysis on clinical characteristics of Kawasaki disease with joint involvement in children

ZHANG Sheng, PIAO Jinhua, LIANG Xue   

  1. Department of Pediatric Cardiology, First Hospital, Jilin University, Changchun 130021, China
  • Received:2018-03-22 Online:2018-07-28 Published:2018-07-27

摘要: 目的:探讨川崎病伴有关节受累患儿的临床特征,明确关节受累是否会对川崎病患儿的冠状动脉损害率、对静脉注射用丙种球蛋白(IVIG)反应性和预后产生影响。方法:选择诊断明确且资料完整的川崎病患儿636例,根据有无关节局部症状,分为关节受累组(31例)和无关节受累组(605例)。回顾性分析川崎病患儿的临床资料和辅助检查资料,比较关节受累组与无关节受累组患儿临床特征、实验室指标、冠状动脉损害率和对IVIG的反应率。结果:31例伴有关节受累的川崎病患儿中,3岁以上患儿25例(80.6%),诊断为完全性川崎病26例(83.9%),多关节(≥2个关节)受累24例(77.4%),大关节受累26例(83.9%),其中以膝关节受累最常见(20例,64.5%)。关节局部症状持续时间不等,经追踪随访,均无关节局部后遗症发生。与无关节受累组比较,关节受累组患儿的发热时间长(P<0.05),白细胞(WBC)计数、中性粒细胞百分比和C反应蛋白(CRP)水平明显升高(P<0.05),但冠状动脉损害率差异无统计学意义(P>0.05)。关节受累组患儿的IVIG无反应率(39.3%)高于无关节受累组(10.9%),2组比较差异有统计学意义(P<0.05)。结论:川崎病伴有关节受累多发生于3岁以上患儿,且倾向于多关节受累,以大关节受累多见,其中以膝关节受累最常见。川崎病伴有关节受累时,对冠状动脉损害率无明显影响,但患儿对IVIG反应性更差。关节受累为川崎病的短暂性症状,不会遗留后遗症。

关键词: 川崎病, 冠状动脉损害, 静脉注射用丙种球蛋白, 关节病变

Abstract: Objective:To explore the clinical characteristics of the Kawasaki disease children with joint involvement,and to determine whether joint involvement will affect the coronary artery damage rate, intravenous immunoglobulin (IVIG) reactivity and prognosis in the children with Kawasaki disease. Methods:A total of 636 cases of children with Kawasaki disease with clear diagnosis and complete informations were selected.According to whether there were the local symptoms of the joints or not,they were divided into joint involvement group(n=31) and non-joint involvement group(n=605).The clinical and auxiliary examination data of the Kawasaki disease children were retrospectively analyzed.The clinical features,laboratory indexes,coronary artery damage rate and IVIG response rate of the children were compared between joint involvement group and non-joint involvement group. Results:Among 31 Kawasaki disease child patients with joint involvement,there were 25 cases(80.6%)of children more than 3 years old,26 cases(83.9%)) diagnosed with complete Kawasaki disease,24 cases(77.4%) of multiple joint involvement (≥ 2 joints),26 cases(83.9%) of big joint involvement,and the knee joint involvement was more common (20 cases,64.5%).The duration of joint local symptoms varied,and no local joint sequelae occurred after follow-up.The fever time of the children in joint involvement group was longer than that in non-joint involvement group,and the difference was statistically significant(P<0.05).The number of WBC,neutrophil percentage and C-reactive protein level of the children in joint involvement group were higher than those in non-joint involvement group,and the difference was statistically significant(P<0.05).There was no significant difference in coronary vascular damage rate between two groups(P>0.05).The IVIG non-response rate of the children in joint involvement group was higher than that in non-joint involvement group(39.3% vs 10.9%),and the difference was statistically significant(P<0.05). Conclusion:Kawasaki disease with joint involvement mostly occurs in the children over 3 years old.When Kawasaki disease accompanies with joint involvement,it tends to multiple joint involvement(≥ 2 joints),more common in the big joint,especially in knee joint involvement. Kawasaki disease accompanying with joint involvement has no affect on the incidence of coronary artery lesions,but it behaves poor reactivity to IVIG.Joint involvement is a transient symptom of Kawasaki disease,and there are no sequelae occurred.

Key words: joint lesion, coronary artery lesion, Kawasaki disease, intravenous immunoglobulin

中图分类号: 

  • R725.4