论文部分内容阅读
川崎病(KD)是儿童时期一种急性自限性血管炎,以发热、双侧非渗出性结膜炎、口唇及口腔黏膜充血、肢端改变、皮疹和颈部淋巴结病变为临床特征,15%～25%未经治疗KD患儿可出现冠状动脉瘤或冠状动脉扩张,并可能引起缺血性心脏病或猝死。多个学科的小儿KD专家修订了既往美国心脏病协会制定的KD诊断、治疗和长期随访指南。该委员会提出了一项关于不完全性KD的诊治策略,以帮助临床医师提高该类患儿的诊治水平。该委员会还针对应用IVIG治疗无反应或复发的KD患儿进行了文献复习并提出治疗建议,对应用糖皮质激素、TNF-α拮抗剂及阿昔单抗治疗KD进行了评价。该委员会提出的KD长期随访方案主要根据患儿的冠状动脉病变程度进行,长期随访治疗方案建议中包括抗血小板治疗和抗凝治疗的方法、体力活动的建议及随访方法的建议,并且根据患者的危险分层对心血管并发症的评价方法进行了规范。对KD最初评估、急性期治疗和长期随访的建议预期可帮助医师采用更加合理的方法处理KD患儿。但最终的处理方案还应依靠临床医师根据患儿的实际情况进行个体化治疗。
Kawasaki disease (KD) is an acute self-limiting vasculitis in childhood characterized by fever, bilateral non-exudative conjunctivitis, congestion of the lips and oral mucosa, extremity changes, rashes and cervical lymph node disease15 % ~ 25% of untreated children with KD may have coronary aneurysm or coronary artery dilation, and may cause ischemic heart disease or sudden death. Pediatric KD specialists from multiple disciplines revised the KD guidelines for diagnosis, treatment, and long-term follow-up to previous American Heart Association. The committee proposed a diagnosis and treatment strategy for incomplete KD to help clinicians improve the diagnosis and treatment of such children. The committee also reviewed the literature and proposed treatment recommendations for patients with KD who did not respond or relapse with IVIG, and evaluated the use of glucocorticoids, TNF-α antagonists, and abciximab in the treatment of KD. The long-term follow-up of KD proposed by the committee is mainly based on the degree of coronary artery disease in children. Long-term follow-up treatment recommendations include antiplatelet therapy and anticoagulation therapy, physical activity recommendations and follow-up recommendations, The risk stratification regulates the evaluation of cardiovascular complications. Recommendations for initial assessment of KD, acute treatment, and long-term follow-up are expected to help physicians use a more rational approach to treating children with KD. But the final treatment program should also rely on the clinician to individualized treatment based on the actual situation in children.