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目的探讨川崎病伴有泌尿系受累患儿的临床特征及转归。方法回顾性分析川崎病患儿的临床及辅助检查资料,比较伴或不伴泌尿系受累患儿两组间临床特征的差异及对丙种球蛋白治疗的敏感性。结果诊断明确且资料完整的川崎病患儿797例,泌尿系受累者105例(13.2%)。男女比例为2∶1,尿检异常以白细胞尿多见[74例(70.5%)]。9例(52.6%)患儿尿检肾早期损害指标(包括Ig G或微量白蛋白或β2微球蛋白)提示升高。67例患儿行超声检查,3例患儿超声提示双肾增大,5例提示回声增强。58例患儿复查尿常规,89.7%的患儿在1周之内恢复。泌尿系受累患儿出现发热、淋巴结肿大及口唇改变的比例显著高于无泌尿系受累组(P<0.05),但冠状动脉受累比例的差异无统计学意义(P>0.05)。泌尿系受累组对丙种球蛋白冲击后不敏感比例升高(16.2%vs.7.2%),但组间差异无统计学意义(P>0.05)。结论川崎病患儿泌尿系统损伤以白细胞尿为多见,多于1~2周内恢复。泌尿系受累患儿发热、淋巴结肿大及口唇改变显著,对冠脉损伤无显著影响,对丙种球蛋白冲击不敏感比例有增高趋势。
Objective To investigate the clinical characteristics and prognosis of Kawasaki disease patients with urinary tract involvement. Methods The clinical and laboratory examinations of children with Kawasaki disease were retrospectively analyzed. The clinical characteristics and the sensitivity to gamma globulin therapy were compared between two groups with and without urinary tract involvement. Results A total of 797 children with Kawasaki disease and 105 urinary tract involvement (13.2%) were diagnosed. Male to female ratio of 2: 1, abnormal urinalysis to more common white blood cells [74 cases (70.5%]]. Nine cases (52.6%) of children with early detection of renal damage indicators (including Ig G or micro-albumin or β2 microglobulin) prompted an increase. 67 cases of children underwent ultrasound examination, three cases of ultrasound showed increased kidneys, 5 cases prompted echo enhancement. 58 cases of children rechecked urine routine, 89.7% of children recovered within 1 week. The incidence of fever, lymph nodes and lip changes in children with urinary tract involvement were significantly higher than those without urinary tract involvement (P <0.05), but the proportions of coronary artery involvement were not statistically significant (P> 0.05). Urinary tract involvement was not sensitive to gamma globulin after shock (16.2% vs.7.2%), but there was no significant difference between the two groups (P> 0.05). Conclusion The urinary tract injury in children with Kawasaki disease is more common in leucocytosis, more than 1 ~ 2 weeks recovery. Urinary tract involvement in children with fever, swollen lymph nodes and significant changes in the mouth, no significant impact on coronary lesions, the impact of gamma globulin insensitivity increased trend.