目的:川崎病(KD)是一种急性自限性全身性血管疾病,常见于5岁以下儿童。本研究比较了不同年龄段诊断为KD的儿童的临床特征。此外,我们对KD的临床特征和诊断指南进行了全面的文献综述.
方法:这是一项对孙逸仙纪念医院收治的KD儿童进行的回顾性研究,广州,中国,从2016年1月到2018年12月。这些孩子被分为3个年龄组,包括1岁以下的儿童(A组,n=66),1-5岁(B组,n=74),和>5岁的儿童(C组,n=14)。完整的临床评估,血液学,并对三组进行了心血管评估和比较.
结果:诊断时间,血红蛋白,A组患儿中性粒细胞比例明显低于其他两组(P<0.05),血小板计数明显增高(P<0.05)。A组中不完全KD(iKD)的比例最大(40.9%),而冠状动脉Z值升高和无菌性脑膜炎的患儿比例高于B组(P<0.0167)。A组KD休克综合征(KDSS)患者较其他两组少(P<0.05)。与其他两组相比,B组出现关节痛的患者最多(P<0.05)。三组静脉免疫球蛋白(IVIG)治疗差异无统计学意义(P>0.05)。
结论:KD发病年龄越小,病情越不典型,影响其他系统的风险更大,冠状动脉疾病的发病率更高。早期使用糖皮质激素治疗可能有助于年龄较大的儿童和具有更高的高风险KD警告评分的儿童预防冠状动脉损伤。
Kawasaki disease (KD) is an acute self-limiting systemic vascular disease commonly observed in children less than 5 years of age. The present study comparatively assesses the clinical characteristics of children diagnosed with KD in different age groups. Furthermore, a comprehensive literature review on the clinical features and diagnostic guidelines of KD is performed.
This was a retrospective study conducted on the data of KD children admitted to the Sun Yat-Sen Memorial Hospital, Guangzhou, China, from January 2016 to December 2018. The children were divided into 3 age groups, including children < 1 year of age (group A, n = 66), 1-5 years of age (group B, n = 74), and children > 5 years of age (group C, n = 14). Complete clinical evaluation, hematological, and cardiovascular assessments were conducted and compared between the three groups.
The time of diagnosis, hemoglobin, and neutrophil ratio of children in group A were significantly lower than the other two groups (p < 0.05), while the platelet count was significantly higher (p < 0.05). The proportion of incomplete KD (iKD) was the greatest in group A (40.9%), while the proportion of children with increased coronary Z value and aseptic meningitis was greater than that in group B (p < 0.0167). Group A showed less patients with KD shock syndrome (KDSS) than the other two groups (p < 0.05). Group B showed the greatest number of patients with arthralgia compared to the other two groups (p < 0.05). Three groups showed no significant difference to intravenous immunoglobulin (IVIG) therapy (p > 0.05).
The younger the age of KD onset, the more atypical the conditions are, with a greater risk of affecting other systems and a higher incidences of coronary artery disease. An early treatment with glucocorticoids might be helpful in older children and those with a greater high-risk KD warning score to prevent coronary injury.