【作者】 李晓梅；

【导师】 李亚蕊； 邱运树；

【作者基本信息】 山西医科大学 ， 儿科学， 2006， 硕士

【摘要】 目的为川崎病(KD)治疗、随访及判断预后提供临床依据。方法对2002年6月～2003年12月123例住院KD患儿进行为期2年的随访研究,重点监测超声心动图(UCG)异常及其恢复情况,⑴分析静脉丙种球蛋白(IVGG)1 g/(kg·d)治疗1～2 d联合口服阿司匹林(ASA)方案的疗效;⑵随访心血管并发症的恢复情况。结果⑴IVGG在5 d内应用及血清白蛋白的量为首剂IVGG非敏感的独立相关因素。首剂IVGG非敏感的12例KD患儿对第2剂IVGG均敏感。⑵冠状动脉轻度扩张43例,22例(51.2%)在半年内恢复,35例(81.4%)在1年内恢复,42例(97.7%)在2年内恢复。初发10 d内接受IVGG 1 g/(kg·d)治疗1～2 d的病例冠状动脉瘤发生率(3.5%)较低。10例冠状动脉瘤,5例(50%)2年后仍未恢复,其中包括2例巨大冠状动脉瘤(内径>8 mm)。无心肌梗死及死亡病例。⑶再发病例6例,其中1例有新的冠状动脉损害形成,3例原有冠状动脉损害加重。3例在初发病2月内再发者,其中1例未用IVGG及ASA治疗,2例热退后ASA快速减量。采用ASA快速减量与缓慢减量治疗相比在2月内其再发率较高。⑷3例患儿的冠脉损害于2～6月间加重,加重前均有上呼吸道感染史。⑸恢复期后口服小剂量ASA未见明显副作用。⑹118例ESR>10 mm/h,均在12～90 d内恢复正常(≤10 mm/h),其中71例/123例(57.7%)在病程20～40 d内恢复。结论⑴KD确诊病例尽早给予单剂IVGG 1 g/kg治疗,非敏感病例给予第2剂IVGG 1 g/kg,利于降低冠脉瘤发生率。⑵轻度冠脉扩张大都(81.4%)在1年内恢复,50%的冠脉瘤在2年内恢复。⑶ASA缓慢减量可能有利于降低KD 2月内的再发率。⑷KD恢复期后呼吸道感染可能是冠脉损害加重的诱因。更多还原

【Abstract】 Objectives The aim of this study was to provide clinical evidence for the management and prognosis estimating of Kawasaki disease (KD).Methods Totally 123 patients with KD were hospitalized from Jun. 2002 to Dec. 2003. The remedy [Intravenous gamma globulin (IVGG) 1 g/(kg·d) injection one to two days plus acetylsalicylic acid (ASA) reducing gradually after defervescence] and cardiac compliance within 2 years were analyzed.Results (1) IVGG treatment on day 4 or earlier and serum albumin were independently associated with resistance to high-dose IVGG. All the 12 cases refractory to initial IVGG were sensitive to additional IVGG. (2) 51.2%(22/43) of mild coronary artery dilations (<4 mm) regressed within 6 months, 81.4%(35/43) within 1 year, and 97.7%(42/43) regressed within 2 years. 5 of the 10 coronary artery aneurysms (CAA) remained over 2 years, including 2 giant CAAs (>8 mm). There is no myocardial infarction or death. (3) Among the 6 recurrent cases, one had new coronary artery lesions; three had expanding coronary artery lesions. Among the 3 cases that recurred within 2 months, IVGG and ASA had not been used in one case, and ASA was reduced to low dose just 3 days after defervescence in 2 cases. The cases that recurred within 2 months were more likely to occur in which ASA was reduced to low dose just 3 days after defervescence than those in which gradually. (4) 3 coronary artery lesions exacerbated between 2 to 6 months, and they all had acute upper respiratory infection before that. (5) Low dose aspirin was used at the convalescent- to chronic-stage of KD, when there was no obvious side-effect. (6) Erythrocyte sedimentation rates (ESR) of 118 patients were above 10mm/h. They all decreased to normal (≤10mm/h) in 12 to 90 days , and 71 of them (57.7%) decreased in 20 to 40 days.Conclusions (1) Patients should be treated with IVGG 1 g/(kg·d) as early as possible when diagnosed as KD. Those refractory to initial IVGG should be treated with additional IVGG. It is of much help to a decreased prevalence of CAA. (2) 81.4%(35/43) of mild coronary artery dilations regressed within 1 year, and 50% of CAA regressed within 2 years. (3) Gradually reducing ASA may lead to a lower recurrent rate within the initial 2 months. (4) After the convalescent stage of KD, respiratory infection might be an inducement of expanding coronary artery lesions.更多还原