摘要： 目的 探讨川崎病合并肝功能损害患儿的临床特点和预后。方法 收集940例川崎病患儿的临床资料，根据肝功能指标分为肝功能正常组（n=583）和肝功能损害组（n=357），比较2组患儿性别、年龄、白细胞（WBC）计数、血小板（PLT）计数、C反应蛋白（CRP），红细胞沉降率（ESR）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST），γ-谷氨酰转移酶（GGT）、总胆红素、治疗前发热天数、住院天数、冠状动脉病变、静脉注射免疫球蛋白（IVIG）无反应等指标是否存在差异。结果 2组比较，性别、年龄、WBC计数、ESR的差异无统计学意义（P > 0.05）。肝功能损害组CRP、ALT、AST、GGT、总胆红素、住院天数、IVIG无反应和冠状动脉病变发生率高于肝功能正常组（P < 0.05），PLT计数低于肝功能正常组（P < 0.05），治疗前发热天数短于肝功能正常组（P < 0.05）。多因素logistic回归分析发现，总胆红素升高是IVIG无反应的独立危险因素。结论 川崎病合并肝功能损害较常见，肝功能损害患儿CRP水平更高，住院时间更长，更易出现IVIG无反应和冠状动脉病变。总胆红素升高是IVIG无反应的危险因素。

川崎病合并肝功能损害患儿的临床特点

杨平平, 孙梅

中国医科大学附属盛京医院小儿消化科, 沈阳 110004

收稿日期:2021-05-07出版日期:2022-03-30发布日期:2022-03-16
通讯作者:孙梅E-mail:sunm@sj-hospital.org
作者简介:杨平平(1991-),女,医师,硕士.



关键词: 川崎病, 肝功能损害, 静脉注射免疫球蛋白无反应, 冠状动脉病变
Abstract: Objective To investigate clinical characteristics and prognosis of Kawasaki disease complicated with impaired liver function. Methods Overall, 940 children with Kawasaki disease were divided into two groups:a normal liver function group(n=583) and an impaired liver function group(n=357). Gender, age, white blood cell(WBC) counts, platelet(PLT) counts, C-reactive protein(CRP) levels, erythrocyte sedimentation rate(ESR), alanine aminotransferase(ALT) levels, aspartate aminotransferase(AST) levels,γ-glutamyltranspeptidase(GGT) levels, total bilirubin, fever duration before treatment, hospital days, coronary artery lesion rate, and non-response to intravenous immunoglobulin(IVIG) rate were compared between the two groups. Results There was no significant difference in gender, age, WBC count, and ESR between the two groups(P > 0.05). However, CRP, ALT, AST, GGT, and total bilirubin levels; hospital days; non-response to IVIG rate; and coronary artery lesion rate were higher in the impaired liver function group than in the normal liver function group(P < 0.05). Additionally, the impaired liver function group had lower PLT counts and shorter fever duration before treatment than the normal liver function group(P < 0.05). Multivariate logistic analysis showed that elevated total bilirubin levels were high-risk factors for non-response to IVIG. Conclusion Kawasaki disease is commonly complicated with impaired liver function and is characterized by higher CRP levels, longer hospital days, and higher non-response to IVIG and coronary artery lesion rates. Moreover, elevated total bilirubin levels are risk factors for non-response to IVIG.
Key words: Kawasaki disease, impaired liver function, non-response to intravenous immunoglobulin, coronary artery lesion
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