刘玉玲 1付四毛 1李小琳 1林汉炼 1陈明 2李性希3
作者信息
- 1. 广东省中山市博爱医院,儿科,广东中山,528403
- 2. 广东省中山市博爱医院,心电图室,广东中山,528403
- 3. 广东省中山市博爱医院,心超室,广东中山,528403
- 折叠
摘要
Abstract
Objective To explore the clinical features, etiological factors, treatments and prognosis of 100 cases of Kawasaki disease(KD). Methods Totally 100 patients with KD in our department treated from 2000 to 2005 was included in the study. A retrospective study was carried ont to analyze clinical characteristics, treatment and outcomes of these patients. Results Clinical features: age of onset (2.01 ± 1.35) years, the age of follow-up (8.2 t 1.68) years;male to female ratio was 1.7∶ 1. Tipical KD (88), including recurrence KD (2), incomplete KD (12). Cardiova-scular complications existed in 25 patients,including coronary artery complications(22), pericardial effusion(2), myocarditis( 1 ) ,transient coronary artery ectasia (18) and coronary aneurysm formation (4), (small tumors in 1 case, medium-sized tumor in 2 cases and a huge tumor in 1 case). Non-cardiovascular complications cases included hepatitis or impaired liver function (34), gallbladder hydrops (3), paralytic intestinal obstruction ( 1 ), aseptic meningitis (3) , facial palsy (5), pneumonia (53), urethritis (12) and arthritis (6). Treatment and efficacy: 89 patients within 10 days of the course were given IVIG 2 g/kg; 12 patients without response were given a 2nd IVIG; 2 IVIG non-responsive patients were added the use of glucocorticoid; 11 cases diagnosed as subacute were given IVIG 1 ～ 2 g/(kg-d), 3 cases with coronary aneurysm formation (P ＜ 0.05 ).Those without coronary artery lesions withdrawed the treatment at the course of 6 to 8 weeks; 18 patients with coronary artery dilation were tracked from 6 months to 1 year to discontinuation; 3 cases of small and medium-sized coronary aneurysm withdrawed in the course of 1 to 3 years; 1 case of giant coronary aneurysm was given aspirin for 7 years. Follow-up and prognosis: 56 patients were followed up to ≥ 5 years, up to 10 years. Abnormal follow-up echocardiography occurred in 10 cases (17.8％ ).Among them, 1 case of giant coronary artery aneurysms was currently still on the expansion of tumor-like coronary artery, for the others the pulmonary valve or tricuspid valve regurgitation and cardiac function were normal. Exercise EECG abnormalities existed in 17 cases (30.3％ ). Among them, 5 cases were with cardiovascular complications (5) (P ＞ 0.05 ). The course of 4 cases with coronary aneurysm had no obvious abnormalities of exercise ECG. Non-cardiovascular complication cases recovered completely. No deaths occurred. Conclusion Most of KD coronary complications are transient coronary artery ectasia. The occurrence of coronary aneurysm is related to the time of diagnosis and use of IVIG. No specific changes of the exercise ECG exist in the patients with coronary artery complication who are in the acute period and have been followed for five years. The patients with more EECG abnormalities need long-time follow-up. Non-cardiovascular complications involve multiple systems, but the prognosis is good.关键词
临床特征/随访/川崎病/儿童Key words
clinical features/ follow-up/ Kawasaki disease/ children分类
医药卫生
