2011年-2015年盐城市川崎病住院病例临床特征分析

发布时间：2018-05-04 10:38

本文选题：盐城市 + 川崎病　；参考：《苏州大学》2016年硕士论文

【摘要】：目的为了掌握盐城地区川崎病(Kawasaki disease,KD)住院患儿的临床特征,探讨本地区KD患儿发生冠状动脉病变(coronary artery lesion, CAL)的危险因素和初步研究不完全KD的临床特点,为提高KD的诊治水平提供循证依据。方法收集盐城市仅有的3家三级甲等医院即盐城市第一人民医院、盐城市妇幼保健院和盐城市第三人民医院于2011年1月至2015年12月期间确诊为KD并收入住院的201例患儿的临床资料。采用SPSS19.0统计软件进行统计处理分析,计数资料用例数(n)或百分比(%)描述,采用卡方检验分析；计量资料用均数士标准差(x±s)描述,采用t检验分析。对发生CAL的危险因素先进行单因素分析,筛选出具有统计学意义的变量,再进行多因素的Logistic回归分析,P0.05表示差异有统计学意义。结果(1)201例病例中,病例数有逐年增多趋势,2011年共确诊川崎病患儿22例,2012年共23例,2013年共46例,2014年共54例,2015年共56例。(2)KD全年均可发病,一年四季中,春季(3-5月)共63例,占31.3%,夏季(6-8月)共62例,占30.8%,秋季(9-11月)共38例,占18.9%,冬季(12-2月)共38例,占18.9%。可见5-6月为发病高峰,11月发病例数最低。春夏季发病例数高于秋冬季,其中春夏之交发病例数最高。(3)201例患儿中男孩127例(占63.2%),女孩74例(占36.8%),男女比例为1.72：1,各年龄组男孩发病例数均高于女孩。(4)临床症状出现频率由高到低依次为发热(100.0%)、球结膜充血(90.0%)、口腔黏膜改变(89.0%)、多形性皮疹(73.1%)、肢端末端改变(72.5%)、颈部淋巴结肿大(53.0%)、肛周脱皮(34.0%)、卡疤红肿(16.5%)。(5)不同年龄完全KD组与不完全KD组的比较：年龄6月KD患儿不完全KD发病率高于完全KD。(6)除肛周脱皮、卡疤红肿外,完全KD组皮肤黏膜改变表现均高于不完全KD组。(7)单因素Logistic回归分析显示：KD合并CAL的危险因素有男性、年龄1岁、总发热时间10天、白细胞(White blood cell,WBC)、血小板(platelet,PLI)、C-反应蛋白(C-reactive Protein, CRP)、血沉(erythrocyte sedimentation rate,ESR)升高以及血红蛋白(hemoglobin,HB)下降；多因素Logistic回归分析显示：年龄1岁、总发热时间10天、PLT升高、ESR升高是KD合并CAL的危险因素。结论1.盐城地区3家三甲医院儿科的KD住院病例数逐年上升,好发于春夏之交,发病年龄多小于5岁,不同年龄组男孩发病率均高于女孩。除发热外其主要临床表现以球结膜充血最常见。2.小于6月KD患儿中不完全KD发病率高于完全KD。3.年龄1岁、总发热天数10天、PLT升高、ESR升高可能是KD合并CAL的危险因素。
[Abstract]:Objective to understand the clinical characteristics of Kawasaki disease (Kawasaki disease) in Yancheng area, and to explore the risk factors of coronary artery disease (artery lesion, CAL) and the clinical characteristics of incomplete KD. To improve the level of KD diagnosis and treatment to provide evidence-based basis. Methods the only three Grade 3A hospitals in Yancheng City, the first people's Hospital of Yancheng City, were collected. Clinical data of 201 children with KD diagnosed and admitted in Yancheng Maternal and Child Health Hospital and the third people's Hospital of Yancheng from January 2011 to December 2015. SPSS19.0 statistical software is used for statistical processing and analysis, the counting data is described by the number of cases (n) or percentage), the chi-square test is used, the measurement data is described by the standard deviation of the mean value (x 卤s), and the analysis by t test is used. The risk factors of CAL were analyzed by univariate analysis, the variables with statistical significance were screened out, and then the multivariate Logistic regression analysis showed that the difference was statistically significant. Results among 201 cases, the number of cases increased year by year. There were 22 cases of Kawasaki disease diagnosed in 2011, 23 cases in 2012, 46 cases in 2013, 54 cases in 2014, 56 cases in 2015. There were 62 cases (30.8%), 38 cases (18.9%) in September and November, and 38 cases (18.9%) in winter. It can be seen that May-June is the peak incidence of the disease, November the lowest number of cases. The number of cases in spring and summer is higher than that in autumn and winter. Among them, 127 cases of boys (63.2%) and 74 cases of girls (36.8%, the ratio of 1.72% to 1.72%) of boys in spring and summer were higher than those of girls. The frequency of occurrence of clinical symptoms in every age group was higher than that of girls. 4) the frequency of clinical symptoms was fever in the order of high to low. 100.010. 0: including 90.0% of bulbar conjunctiva, 89.0% of oral mucosal changes, 73.1% of pleomorphic rash, 72.5% of extremity end, 53.0% of neck lymph node enlargement, 34.0% of perianal desquamate, 16.55% of scar redness.) comparison between complete KD group and incomplete KD group at 6 months of age: The incidence of incomplete KD was higher than that of complete KD.6). Except scar redness and swelling, the changes of skin and mucosa in complete KD group were higher than those in incomplete KD group. The univariate Logistic regression analysis showed that the risk factors of CAL were male (1 year old), and the total fever time was 10 days. The multivariate Logistic regression analysis showed that the increase of C-reactive protein (CRPN) and the decrease of erythrocyte sedimentation ratein (blood) and hemoglobulin B (HBB) were the risk factors of KD complicated with CAL in the age of 1 year and the total fever time of 10 days. Conclusion 1. The number of KD cases in pediatrics of 3 third Class A hospitals in Yancheng area increased year by year, which occurred at the turn of spring and summer. The incidence of KD in boys of different age groups was higher than that of girls. In addition to fever, the main clinical manifestations of bulbar conjunctiva hyperemia is the most common. 2. The incidence of incomplete KD was higher than that of complete KD 3 in children with KD less than 6 months. The age of 1 year and the total fever days of 10 days were increased and the elevation of ESR might be the risk factor of KD complicated with CAL.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.4

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