皮肤粘膜淋巴结综合征10年临床变迁

发布时间：2018-06-19 15:18

本文选题：川崎病 + 皮肤粘膜淋巴结综合征　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：通过观察10年前后川崎病的临床特征及心血管改变,探讨川崎病10年临床特征的变化,以助KD的早期确诊,预防冠心病的发生。方法：采用回顾性分析的方法,收集2001-2003年600例和2011-2013年2040例在重庆医科大学附属儿童医院住院的川崎病患儿为研究对象,记录其发病年龄、男女比例、发病月份、主要临床表现、不完全川崎病比例、彩超结果、丙球使用时间及结果。并对10年前彩超结果按当前诊断标准进行修正。采用SPSS17.0软件进行分析,P值0.05为差异有统计学意义。结果：与10年前相比,10年后男女发病率较前无明显变化(1.66：1 vs.1.76：1,P=0.510)；但发病年龄较前提前(31.20±0.55m vs.33.09±0.89m,P0.05)；特别是婴儿期KD的发病率明显增高(23.6% vs.10.8%,P0.05)；主要发病季节由冬春季变为春夏季,5月为新发病高峰；iKD的比例明显高于10年前(27% vs.22.2%,P=0.017)；小于1岁的iKD患儿比例较前明显增多,差异有统计学意义(P=0.003)；KD复发率高于10年前,但差异无统计学意义(1.4% vs.0.5%,P=0.081)；临床表现最常见的仍为发热,其次为唇与口腔粘膜改变、双眼球结膜充血,较前无明显变化,但颈部淋巴结发生率较前明显减少(57.9%vs.67.8%,P0.05)；冠状动脉病变发生率较前无明显变化(57.7% vs.58.9%,P=0.593),主要为冠状动脉扩张,冠脉瘤的发生率及病变部位较前无明显变化,但冠脉血栓形成有增多趋势；二尖瓣返流的发病率较前增高(31.8% vs.25.2%,P=0.003)但三尖瓣返流为主,其次为二尖瓣返流、肺动脉瓣返流,主动脉返流罕见的趋势不变；KD接受丙球治疗的比例增高(91.7% vs.88.3%,P=0.011),丙球不耐受的发生率较前稍升高,但差异无统计学意义(6.5% vs.4.7%,P=0.126)。结论：10年后KD的发病年龄有减小趋势,尤其婴儿期KD的发病率有增高趋势；主要发病季节由冬春季变为春夏季,5月成为新发病高峰；iKD的发病率较前增高；KD的CAL的发生率较前无明显变化,但冠脉血栓形成有增多趋势。
[Abstract]:Objective: to investigate the clinical characteristics and cardiovascular changes of Kawasaki disease before and after 10 years in order to help the early diagnosis of KD and prevent coronary heart disease. Methods: by retrospective analysis, 600 cases of Kawasaki disease in Chongqing Medical University affiliated Children's Hospital from 2001 to 2003 and 2040 cases of Kawasaki Disease from 2011 to 2013 were collected. The age, sex ratio, month of onset, main clinical manifestations of Kawasaki disease were recorded. Incomplete Kawasaki disease ratio, color ultrasound results, C ball use time and results. The results of color Doppler ultrasound 10 years ago were revised according to the current diagnostic criteria. SPSS 17.0 software was used to analyze P value 0.05 was statistically significant. Results: compared with 10 years ago, there was no significant change in incidence rate of male and female after 10 years compared with that of 10 years ago, but the age of onset was 31. 20 卤0. 55m vs.33.09 卤0. 89mP0.05, especially in infancy, the incidence of KD increased by 23. 6% vs.10.8P0. 05%, but the age of onset was 31. 20 卤0. 55m vs.33.09 卤0. 89mP0. 05, especially in infancy, the incidence rate of KD was increased by 23. 6% vs.10.8P0. 05%. The main onset season changed from winter and spring to spring and summer, and the proportion of IKD in May was significantly higher than that in 10 years ago (27% vs.22.2P0. 017), and the proportion of children younger than 1 year old was obviously higher than that of 10 years ago, the difference was statistically significant, the recurrence rate of P0. 003 / KD was higher than that of 10 years ago. The most common clinical manifestations were fever, followed by lip and oral mucosal changes, double conjunctiva hyperemia and no significant change, but the incidence of cervical lymph nodes was significantly reduced to 57.9 vs.67.8%. There was no significant change in the incidence of coronary artery disease (57.7% vs.58.9%), mainly coronary artery dilatation. The incidence and location of coronary artery aneurysm had no obvious change, but coronary thrombosis had an increasing tendency. The incidence of mitral regurgitation was 31.8% vs 25.2P 0.003, but tricuspid regurgitation was predominant, followed by mitral regurgitation, pulmonary regurgitation and aortic regurgitation. The proportion of KD treated with propyl ball increased by 91.7% vs.88.3and 0.011% respectively, and the incidence of the third ball intolerance was slightly higher than that of the former, but there was no significant difference between them (6.5% vs.4.7%, P 0.126). Conclusion: after 10 years, the onset age of KD decreased, especially in infancy, the incidence of KD increased from winter and spring to spring and summer, and from May to new onset peak. The incidence of KD CAL had no significant change, but coronary thrombosis had a tendency to increase.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.4

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