| 不同血压类型川崎病患儿的临床特点分析 |
| 投稿时间：2016-08-19 修订日期：2016-08-22 点此下载全文 |
| 引用本文：薛超超,潘国权,仇慧仙,张园海,李昌崇.不同血压类型川崎病患儿的临床特点分析[J].医学研究杂志,2017,46(4):78-82 |
| DOI：
10.11969/j.issn.1673-548X.2017.04.020 |
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| 基金项目:浙江省医药卫生科技项目（201478482） |
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| 中文摘要:目的 分析不同血压类型川崎病（Kawasaki disease，KD）患儿的临床特点及预后，为临床早期诊断、治疗及预后评估提供经验，并探索其发病机制。方法 本研究纳入2009年1月~2014年12月在温州医科大学附属育英儿童医院诊断为川崎病休克综合征（Kawasaki disease shock syndrome，KDSS）的患儿8例（KDSS组），仅伴有舒张压降低的川崎病（Kawasaki disease with diastolic hypotension，KDDH）患儿21例（KDDH组），同一时期血压正常的KD患儿32例（普通KD组）作为对照组。分析3组患儿的临床特点实验室检查治疗及预后。结果 与普通KD组比较，KDSS和KDDH组患儿年龄> 3岁比例分别为75.0%、71.4%，较普通KD组的21.9%显著增高，KDSS和KDDH组中性粒细胞比例分别为0.90±0.04和0.82±0.08，较普通KD组的0.66±0.15显著升高。KDSS和KDDH组中CRP值分别为221±1160mg/L和168±69mg/L，较普通KD组的73±54mg/L显著升高。KDSS和KDDH组中血白蛋白值分别为22±4g/L和24±6g/L，较普通KD组的31±4g/L显著降低。KDSS和KDDH组中血钠值分别为120.0±7.7mmol/L和123.6±6.7mmol/L，较普通KD组的135.6±2.2mmol/L显著降低。KDSS和KDDH组中胸（腹）腔积液比值分别为87.5%和85.8%，较普通KD组的0%显著升高。另外KDSS组较普通KD组，存在毛细血管再充盈时间（capillary refill time，CRT）（4.17±1.29s vs 2.52±0.72s）、Tei指数异常比例 （75% vs 0%）、左心室射血分数 < 55%比例（37.5% vs 0%）、N末端脑利钠肽前体（NT-proBNP）水平（6192±2990mmol/L vs 739±691mmol/L）、肌钙蛋白I升高比例（75.0% vs 6.3%）、IVIG无反应比例（62.5% vs 6.3%）、冠脉扩张比例（87.5% vs 28.1%）、心电图异常比例（75.0% vs 6.3%）均显著升高。而KDDH组患儿的以上指标与普通KD组比较，差异无统计学意义（P > 0.05）。KDSS组和KDDH组比较，CRT （4.17±1.29s vs 2.92±0.95s）、Tei指数异常比例（75.0% vs 9.5%）、左心室射血分数 < 55%比例（37.5% vs 0%）、NT-proBNP水平（6192±2990mmol/L vs 1063±742mmol/L）、肌钙蛋白-I升高比例（75.0% vs 9.5%）、IVIG无反应比例（62.5% vs 14.3%）、心电图异常比例（75.0% vs 9.5%）均显著升高。结论 KDSS和KDDH患儿年龄较大，全身炎性反应更加剧烈，均出现血管渗漏表现，并且KDSS易导致IVIG无反应及冠状动脉损害，而KDDH介于普通KD和KDSS之间，为病程的过渡阶段。 |
| 中文关键词:川崎病 血压 毛细血管渗漏 休克 |
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| Clinical Manifestations of Kawasaki Disease Shock Syndrome with Different Blood Pressure |
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| Abstract:Objective To investigate the clinical characteristics of Kawasaki disease with different blood pressure, therefore to improve its diagnosis and prognosis. Methods Eight patients with KDSS (KDSS group), 21 patients with KDDH (KDDH group) and 32 hemodynamically stable Kawasaki disease patients (control group) from the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University between January 2009 and December 2014 were enrolled in the study. The clinical features, laboratory examination, treatment and prognosis of all the patients were observed and compared between the three groups. Results Compared with the control group, the age of onset of the patients in the KDSS group and KDDH group were older, the age of onset >3 years (75.0% and 71.4% vs 21.9%), the levels of percentage of neutrophils (0.90±0.04 and 0.82±0.08 vs 0.66±0.15), C reactive protein (221±116mg/L and 168±69mg/L vs 73±54mg/L) and the rate of pleural or peritoneal effusion (87.5% and 85.8% vs 0%) were significantly higher, while the serum albumin (22±4g/L and 24±6g/L vs 31±4g/L) and sodium levels (120.0 7.7mmol/L and 123.6±6.7mmol/L vs 135.6±2.2mmol/L) were significantly lower. In addition, KDSS group had higher levels in CRT (4.17±1.29s vs 2.52±0.72s), the rate of abnormal Tei index (75.0% vs 0%), the rate of left ventricular ejection fraction < 55% (37.5% vs 0%), NT-proBNP levels (6192±2990mmol/L vs 739±691mmol/L), the rate of elevated troponin I levels (75.0% vs 6.3%),the rate of IVIG non-response (62.5% vs 6.3%),the rate of coronary dilatation (87.5% vs 28.1%), and the rate of EKG abnormality (75.0% vs 6.3%) than these in control group, while KDDH group had no significantly difference in above indicators compared with the control group. KDSS group had higher CRT (4.17±1.29s vs 2.92±0.95s), the rate of abnormal Tei index (75.0% vs 9.5%), the rate of left ventricular ejection fraction < 55% (37.5% vs 0%), NT-proBNP levels (6192±2990mmol/L vs 1063±742mmol/L), the rate of elevated troponin-I levels (75.0% vs 9.5%), the rate of IVIG non-response (62.5% vs 14.3%), and the rate of EKG abnormality (75.0% vs 9.5%) than these in KDDH group. Conclusion KDSS and KDDH patients had older age of onset, obvious systemic inflammatory reaction, resulting in the features of capillary leak syndrome. IVIG non-response and coronary dilatation were occurred easily in KDSS patients, and KDDH was a phase of pathophysiologic transition between ordinary KD and KDSS. |
| keywords:Kawasaki disease Blood pressure Capillary leak Shock |
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