章晓英 李超雄 傅雯静 赵海丰 裴夏南 李王彬

[摘要] 目的 總结并探讨川崎病（KD）住院患儿的临床特征，为临床治疗提供指导。 方法 回顾性分析2009年9月～2017年9月我院住院的269例川崎病患儿临床资料：（1）比较典型川崎病与不典型川崎病的临床特征；（2）以静脉用丙种球蛋白（IVIG）疗效为标准进行分组，探讨初始剂量静脉用丙种球蛋白治疗敏感性川崎病与无反应川崎病的临床特征。 结果 ①典型川崎病组各项临床症状的发生率均高于不典型川崎病组（P<0.05）。不典型KD组冠状动脉损伤发生率高于典型KD组（P<0.05）；实验室检查中，除了CRP外（P<0.05），两组其余实验室检查指标比较，差异无统计学意义（P>0.05）。②以静脉用丙种球蛋白（IVIG）疗效为标准进行分组，除口唇、肛周改变外，IVIG敏感性川崎病其余临床症状发生率高于IVIG无反应性川崎病（P<0.05）。除CRP、ALT、AST外，两组其余实验室检查结果及冠脉改变比较无差异（P>0.05）。 结论 川崎病患儿应强调早期评估临床参数，对高度怀疑为川崎病患儿应多次复检提高阳性率，尤其注意CRP的变化，对无反应川崎病注意肝功能变化。

[关键词] 川崎病；临床特征；静脉用丙种球蛋白

[中图分类号] R725.4 [文献标识码] B [文章编号] 1673-9701（2018）30-0048-03

[Abstract] Objective To summarize and explore the clinical features of hospitalized children with Kawasaki Disease （KD） and provide guidance for clinical treatment. Methods The clinical data of 269 children with Kawasaki disease who were hospitalized in Jiangmen Central Hospital from September 2009 to September 2017 were retrospectively analyzed. The clinical features of typical Kawasaki disease and atypical Kawasaki disease were compared. The efficacy of intravenous gamma globulin （Intravenous Immune Globulin IVIG） was grouped， to investigate the clinical features of the initial dose of intravenous gamma globulin for the treatment of Kawasaki disease non-responsive Kawasaki disease. Results 1.The incidence of clinical symptoms in the typical Kawasaki disease group was higher than that in the atypical Kawasaki disease group （P<0.05）. The incidence of coronary artery injury in the atypical KD group was higher than that in the typical KD group（P<0.05）. In the laboratory examination， except for CRP（C-Reactive Protein） （P<0.05）， there was no significant difference in the other laboratory examination indexes between the two groups（P>0.05）. 2.According to the efficacy of intravenous gamma globulin（IVIG） as the standard， the patients were grouped. Except for lip and perianal changes， the incidence of clinical symptoms in IVIG-sensitive Kawasaki disease was higher than that of IVIG-unresponsive Kawasaki disease（P<0.05）. Except CRP， ALT and AST， there was no difference in the other laboratory results and coronary artery change in the two groups（P>0.05）. Conclusion The early evaluation of clinical parameters in children with Kawasaki disease should be emphasized. Patients with high degree of suspicion of Kawasaki disease should be re-examined several times to increase the positive rate. Particular attention to changes in CRP should be paid， and the changes in liver function in IVIG-unresponsive Kawasaki disease should be paid attention to.

[Key words] Kawasaki disease； Clinical features； Intravenous gamma globulin

川崎病（Kawasaki disease，KD）是一种全身性血管炎症性疾病，主要多见于5岁以下儿童，主要影响中型动脉，尤其会使其冠状动脉损害（Coronary artery lesion，CAL）风险明显增加[1]。在发达国家，KD是儿童获得性心脏病最常见的病因。KD的病因尚不清楚，目前人们认为，一种或多种尚未确认的感染性因子在基因易感个体中诱发了强烈的炎症宿主反应。静脉注射用免疫球蛋白（Intravenous immune globulin，IVIG）和/或阿司匹林仍是治疗这种疾病的唯一选择，但仍有10%～15%的患儿对这种治疗产生了耐药性[2]。本文对我院269例川崎病住院患儿的临床资料进行回顾性分析，总结比较KD的临床特征，以指导临床治疗。……