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目的观察川崎病(Kawasaki,KD)的临床特征、大量静脉免疫球蛋白(Intravenous Immunoglobulin,IVIG)治疗前后实验室检查的变化以及随访结果。方法对29例KD患者临床资料、实验室检查和随访结果进行回顾性分析和总结。收集同期住院治疗24例非感染患者作为对照组,记录对照组血液学检查结果,并与KD组进行比较。结果①29例KD患者中,IVIG敏感型25例,IVIG无反应型4例;超声心动图结果显示,冠脉正常16例,冠脉扩张(Coronary Artery Dilation,CAD)9例,冠脉瘤(Coronary Artery Aneurism,CAA)4例。②与对照组比较,治疗前KD患者血白细胞(Write Blood Cell,WBC)、中性粒细胞百分比(neutrophilicgranulocyte,N%)明显增高,淋巴细胞百分比(lymphocyte,L%)明显降低,治疗后WBC、N%和L%与对照组比较无显著性差异。③与KD患者治疗前比较,治疗后WBC、N%和C反应蛋白(C-reactive protein,CRP)明显降低,L%明显升高,血沉(Erythrocyte Sedimentation Rate,ESR)变化不明显,血小板(Blood Platelet,PLT)不受治疗影响而逐渐升高。④22例KD患者进行随访,12例冠脉正常者无新发病变,8例CAD完全恢复正常,1例CAA病变加重,1例CAA不完全恢复。结论大剂量IVIG治疗KD效果满意,WBC、N%、L%和CRP短期内回复正常,可以作为反应急性期病情变化的指标。对IVIG无反应型KD须引起重视,以便及时采取积极有效的治疗措施。
Objective To observe the clinical characteristics of Kawasaki disease (KD) and the changes of laboratory tests before and after treatment with intravenous immunoglobulin (IVIG) and the follow-up results. Methods The clinical data, laboratory tests and follow-up results of 29 KD patients were retrospectively analyzed and summarized. Twenty-four noninfectious patients in the same period of hospitalization were collected as the control group, and the results of hematology examination in control group were recorded and compared with KD group. Results ① Among the 29 KD patients, 25 were IVIG-sensitive and 4 were non-responsive IVIG. Echocardiography showed 16 cases of normal coronary artery, 9 cases of coronary artery stenosis (CAD), 9 cases of coronary artery aneurysm (Coronary Artery Aneurism, CAA) in 4 cases. ②Compared with the control group, the WBC and neutrophilic granulocyte (N%) of patients with KD before treatment were significantly increased and the percentage of lymphocytes (L%) was significantly decreased. After treatment, WBC, N% and L% compared with the control group no significant difference. ③ Compared with KD patients before treatment, WBC, N% and C-reactive protein (CRP) were significantly decreased, L% was significantly increased, Erythrocyte Sedimentation Rate (ESR) Platelet, PLT) were not affected by treatment and gradually increased. Twenty-two patients with KD were followed up. Twelve newborns with normal coronary arteries had no new lesion. Eight of CAD patients returned to normal completely. One case of CAA increased and one case of CAA did not recover completely. Conclusion High dose IVIG treatment of KD is satisfactory, WBC, N%, L% and CRP returned to normal in a short period of time, which can be used as an indicator of the changes in the acute stage of disease. IVIG non-responsive KD attention, in order to take timely and effective treatment.