云南省川崎病发病特征临床研究

杨慧波; 缪勤; 刘德良; 李斯斯

doi:10.12259/j.issn.2095-610X.S20201121

云南省川崎病发病特征临床研究

doi: 10.12259/j.issn.2095-610X.S20201121

1.
云南省第三人民医院儿科，云南昆明　650011
2.
昆明医科大学第一临床医学院，云南昆明　650500

基金项目: 云南省科技保障民生发展计划科研基金项目（2017-1-s-16758）

详细信息

作者简介:
杨慧波（1968～），女，云南建水人，医学学士，副主任医师，主要从事儿科临床工作

通讯作者:
李斯斯，E-mail：1352614967@qq.com

中图分类号: R725.4
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出版历程
- 收稿日期: 2020-08-11
- 网络出版日期: 2020-12-03
- 刊出日期: 2020-11-25

Clinical Study on Characteristics of Kawasaki Disease in Yunnan Province

1.
Dept. of Pediatrics，The Third People’s Hospital of Yunnan Province，Kunming Yunnan 650011
2.
The first Clinical Medical College of Kunming Medical University，Kunming Yunnan 650500，China

摘要

摘要: 目的探讨川崎病（Kawasaki disease，KD）在云南儿童间的发病和临床特征。方法回顾性分析云南省第三人民医院2013年1月至2018年12月间入院的163例川崎患者的资料，分析其临床特征与淋巴细胞亚群特点。结果患者年龄跨度较大（0～8岁），其中0～2岁患者占59.51%，患者出现结膜充血、口唇皲裂、皮疹、血沉（ESR）增快，C反应蛋白（CRP）升高、血小板增多，白细胞增高。此外患者还出现四肢末端改变、颈部淋巴结肿大、肛周皮肤潮红、卡巴症、贫血、中性粒细胞异常、WBC小于4 000等症状。心脏彩超结果显示，川崎病人心脏出现内膜不光滑、左右冠状动脉有扩张的症状。93.66%的川崎病患者CD19⁺升高，其他淋巴细胞亚群也出现变化，并且CD3⁺CD8⁺和CD3⁺CD4⁺与患者年龄相关（相关系数 > 0.2）。结论 2岁以下儿童为易感群体，且患者急性期存在显著的免疫学紊乱，结合川崎病表征、血液指标、心脏彩超以及淋巴细胞亚群变化来进行诊断将更加科学合理。
- 川崎病 /
- 临床特征 /
- 淋巴细胞亚群 /
- 年龄相关
Abstract: Objective To investigate the incidence and clinical features of Kawasaki disease（KD）among children in Yunnan province. Methods A total of 163 patients with Kawasaki disease were studied retrospectively. All of them were treated in the Third People's Hospital of Yunnan Province in Kunming from January 2013 to December 2018. The clinical features and lymphocyte subpopulations in the patients with Kawasaki disease were analyzed. Results 59.51% of the patients were 0～2 years old. Patients had conjunctival congestion, chapped lips, rash, abnormal erythrocyte sedimentation rate（ESR）, elevated C-reactive protein（CRP）, platelet count greater than 500, and white blood cell（WBC）greater than 10 000. In addition, extremity changes, cervical lymphadenopathy, perianal skin flushing, kappa disease, anemia, neutrophil abnormalities, and WBC less than 4000 were also detected in patients with Kawasaki disease. The results of color Doppler ultrasound showed that the intima of Kawasaki patients was not smooth and the left and right coronary arteries were dilated. CD19⁺ was increased in 93.66% of Kawasaki disease patients, and other lymphocyte subsets were also changed. CD3⁺CD8⁺ and CD3⁺CD4⁺ were significantly correlated with age（Pearson Correlation Coefficicient > 0.2）. Conclusion Children under 2 years old are susceptible groups, and there are significant immunologic disorders in acute phase in the patients with Kawasaki disease. It is more scientific and reasonable to diagnose Kawasaki disease by combining the characteristics of Kawasaki disease, blood parameters, cardiac color Doppler ultrasound and lymphocyte subsets.
- Kawasaki disease /
- Clinical features /
- Lymphocyte subsets /
- Age relation

HTML全文

图 1 川崎病人的临床表现（n = 163）

A：川崎病人各年龄段比例；B：川崎病人外表征比例；C：川崎病人血检验指标比例；D：川崎病人心脏彩超异常比例。

Figure 1. Clinical features of the patients with Kawasaki disease（n = 163）

下载: 全尺寸图片幻灯片

图 2 川崎病患者急性期淋巴细胞亚群与年龄相关性分析

A：川崎病患者年龄与CD3⁺相关性分析；B：川崎病患者年龄与CD3⁺CD8⁺相关性分析；C：川崎病患者年龄与CD3⁺CD4⁺相关性分析；D：川崎病患者年龄与CD19⁺相关性分析；n = 142；每个圆点代表一个个体，黑色圆点为正常范围内的检测值，红色圆点为异常检测值。Pearson相关系数 < 0.2为极弱相关或无相关，Pearson相关系数在0.2～0.4间为弱相关。

Figure 2. Correlation analysis of lymphocyte subsets and age in the patients with Kawasaki disease

下载: 全尺寸图片幻灯片

表 1 川崎病人急性期淋巴细胞亚群的变化

Table 1. Changes of lymphocyte subpopulation in the patients with Kawasaki disease

检测项目			检出数（n）	检出率（%）
CD3⁺	正常范围	50%～84%	101	71.13
	异常范围	< 50%	40	28.17
	异常范围	> 84%	1	0.70
CD3⁺CD8⁺	正常范围	15%～44%	91	64.79
	异常范围	< 15%	50	35.21
	异常范围	> 44%	0	0.00
CD3⁺CD4⁺	正常范围	27%～51%	103	72.53
	异常范围	< 27%	33	23.24
	异常范围	> 51%	6	4.23
CD16⁺CD56⁺	正常范围	7%～40%	104	73.24
	异常范围	< 7%	38	26.76
	异常范围	> 40%	0	0.00
CD19⁺	正常范围	5%～18%	9	6.34
	异常范围	< 5%	0	0.00
	异常范围	> 18%	133	93.66
CD4⁺/CD8⁺	正常范围	0.7～2.8	111	78.17
	异常范围	< 0.7	3	2.11
	异常范围	> 2.8	28	19.72

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