摘要
目的分析儿童甲型流感合并川崎病(KD)的临床特征,增强对甲型流感合并川崎病的早期识别。方法对首都医科大学附属北京地坛医院2018年1月1日至2019年12月31日收治的682例实验室确诊的甲型流感患儿资料进行回顾性分析,筛选甲型流感病毒感染合并川崎病儿童共14例(KD+甲流组)。选择同期就诊的符合纳入标准及排除标准的28例KD患儿为KD组,28例单纯甲型流感患儿为甲流组。比较KD+甲流组和KD组患儿临床表现、发热持续时间及冠状动脉病变发生率。比较KD+甲流组、KD组和甲流组患儿白细胞(WBC)、中性粒细胞百分比、淋巴细胞百分比、血小板、快速C-反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)、血清淀粉样蛋白酶A(SSA)、白蛋白、转氨酶和心肌酶水平。结果KD+甲流组患儿发热持续时间[(11.21±3.36)d]较KD组[(6.29±2.21)d]更长,差异有统计学意义(t=5.81、P<0.001)。KD+甲流组丙种球蛋白无反应型(IVIG)比例(42.9%)较KD组(14.3%)更高,差异有统计学意义(χ^2=4.1、P=0.41)。KD+甲流组患儿WBC[(13.18±4.39)×109/L]、ESR[(60.5±15.82)mm/h]、CPR[55.5(17.56,61.0)g/L]、SSA[76.5(23.0,311.6)mg/L]和丙氨酸氨基转移酶(ALT)[49.5(23.1,78.0)U/L]均较KD组和甲流组升高,差异均有统计学意义(F=27.92、P<0.001,F=47.97、P<0.001,Z=3.15、P=0.007,Z=4.36、P<0.001,Z=2.68、P=0.027)。KD+甲流组较KD组患儿冠状动脉扩张发生概率更高(57.0%vs.25.0%),差异有统计学意义(χ^2=4.2、P=0.041)。KD+甲流组患儿IVIG无反应型发生率较单纯KD组高(42.9%vs.14.3%),差异有统计学意义(χ^2=4.1、P=0.041)结论甲型流感合并KD患儿发热时间、明确诊断所需时间较长,其IVIG无反应型发生率更高,且血清SSA和ALT水平显著升高。
Objective To analyze the clinical features of influenza A complicated with Kawasaki disease(KD)in children and enhance its early identification.Methods The medical records of 682 cases with laboratory-confirmed influenza A in Beijing Ditan Hospital,Capital Medical University from January 1st,2018 to December 31st,2019 were analyzed,retrospectively.Among whom,14 children with influenza A virus infection complicated with KD were collected as KD+influenza A group.While 28 cases with KD meeting the inclusion criteria and exclusion criteria were selected as KD group,and 28 cases with influenza A alone as influenza A group,respectively.The clinical manifestations,duration of fever and incidence of coronary artery disease were compared between KD+influenza A group and KD group.The levels of white blood cell(WBC),neutrophil percentage,lymphocyte percentage,platelet,rapid C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),serum amyloid protease A(SSA),albumin,aminotransferase and myocardial enzyme were compared among KD+influenza A group,KD group and influenza A group,respectively.Results The duration of fever in children of KD+influenza A group[(11.21±3.36)d]was significantly longer than that of KD group[(6.29±2.21)d],with significant difference(t=5.81,P<0.001).The levels of WBC[(13.18±4.39)×109/L],ESR[(60.5±15.82)mm/h],CPR[55.5(17.56,61.0)g/L],SSA[76.5(23.0,311.6)mg/L]and alanine aminotransferase(ALT)[49.5(23.1,78.0)U/L]of cases in KD group were significantly higher than those of KD group and influenza A group,with significant differences(F=27.92,P<0.001;F=47.97,P<0.001;Z=3.15,P=0.007;Z=4.36,P<0.001;Z=2.68,P=0.027).The probability of coronary artery dilation of cases in KD+influenza A group was higher than that of KD group(57.0%vs.25.0%),with significant difference(χ2=4.2,P=0.041).The incidence rate of non-response to intravenous immunoglobulin(IVIG)of cases in KD+influenza A group was significantly higher than that of KD group(42.9%vs.14.3%),with significant difference(χ2=4.1,P=0.041).Conclusions The duration of fever and period of definite diagnosis were longer,the incidence rate of non-response to IVIG was higher,and the levels of serum SSA and ALT increased significantly in children with influenza A and KD.
作者
赵扬
王彩英
万钢
张新鑫
何树新
郝一炜
庞琳
Zhao Yang;Wang Caiying;Wan Gang;Zhang Xinxin;He Shuxin;Hao Yiwei;PangLin(Department of Pediatrics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Medical Records,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Party Committee Office,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2020年第3期258-263,共6页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
专病专治重点基金项目(中医药循证能力建设项目)(No.2019XZZX-LG002)。
关键词
儿童
川崎病
甲型流感
Children
Kawasaki disease
Influenza A
