24例儿童川崎病的早期诊断及冠状动脉扩张高危因素分析

目的：探讨川崎病(KD)的早期诊断线索及冠状动脉损害的高危因素。方法：回顾性分析24例KD患儿的年龄、性别、临床表现、血常规及白细胞分类、血小板计数(PLT)、血沉(ESR)、C-反应蛋白(CRP)及心脏彩超测量冠状动脉内径。结果：KD发病以3岁以下的男性患儿居多，发热、唇及口腔黏膜改变、皮疹、球结膜充血(非化脓性)、手足硬肿和颈淋巴结肿大的发生率高达100％、88％、83％、79％、21％、25％。白细胞总数、中性粒细胞分类升高，血沉增快，CRP升高，血小板计数，分别占87．5％、83．3％、82．6％、75％和83．3％。结论：发热患儿早期出现唇充血皲裂及口腔黏膜充血、皮疹、球结膜充血(无分泌物)，同时伴有白细胞总数、中性粒细胞分类升高。血沉增快和CRP升高要高度怀疑KD的诊断，及早进行心脏超声检查了解有无冠状动脉扩张，以确定KD的诊断。3岁以下的男孩，ESR、CRP、肿计数明显升高是冠状动脉扩张(CAD)的高危因素。

Study on early diagnosis and high-risk factors of coronary artery ectasia of Kawasaki disease

Aim: Discussing early diagnosis and high-risk factors of coronary artery lesions of Kawasaki disease.Methods: Retrospective review of 24 children with Kawasaki's disease, information included age, sex, clinical manifestations, development of cardiovascular abnormalities, and incidence rate.Results: Most of the cases occurred before the age of 3 years. The most common clinical features were fever (100%), oral mucosal changes (88%) and rash (83%). The next common features were conjunctivitis (79%), changes in the extremities (21%) and cervical lymphadenopathy (25%). Laboratory findings include elevated WBC count with predominance of neutrophils, thrombocytosis, elevated erythrocyte sedimentation rate, positive C-reactive protein test result.Conclusion: Factors associated with an increased risk of coronary artery ectasia include male sex, age less than 3 year and elevated erythrocyte sedimentation rate, positive C-reactive protein test result.