小儿川崎病合并肺炎支原体感染及冠状动脉病变的临床分析

刘璐; 董淮富

doi:10.13898/j.cnki.issn.1000-2200.2022.10.012

小儿川崎病合并肺炎支原体感染及冠状动脉病变的临床分析

刘璐,
董淮富

Clinical analysis of Kawasaki disease complicated with Mycoplasma pneumoniae infection and coronary artery disease in children

摘要

摘要:
目的探讨川崎病(KD)合并肺炎支原体感染的实验室检查分析，以及并发冠状动脉病变的危险因素分析。
方法选择92例KD患儿，其中患儿合并肺炎支原体感染分为观察组，无肺炎支原体感染分为对照组。对2组患儿进行血C反应蛋白(CRP)、红细胞沉降率(ESR)、天门冬氨酸氨基转移酶(AST)、肌酸激酶同工酶(CK-MB)以及降钙素原(PCT)、血红蛋白(Hb)、血清免疫球蛋白(Ig)及补体等的检测和分析。按照KD患儿有无冠状动脉病变分成冠状动脉病变组、非冠状动脉病变组，筛选出相关因素进行logistic回归分析。
结果92例KD患儿中合并肺炎支原体感染者48例(52.2%)。观察组CRP、ESR、PCT、IgG以及C3均高于对照组(P<0.05~P<0.01)。性别、发热时间、Hb、ESR、肺炎支原体感染、丙种球蛋白无反应与KD患儿并发冠状动脉病变密切相关(P<0.05~P<0.01)；经多因素logistic回归分析显示，KD患儿并发冠状动脉病变的独立危险因素有发热时间≥7d(OR=3.229，P<0.01)、Hb<100g/L(OR=2.114, P<0.05)、肺炎支原体感染(OR=3.356, P<0.01)、丙种球蛋白无反应(OR=3.655, P<0.01)。
结论KD的诱因之一可能为肺炎支原体感染。KD合并肺炎支原体感染与KD患儿的CRP、ESR、PCT、IgG以及C3呈正相关。发热时间≥7d、血红蛋白<100g/L、支原体感染及丙种球蛋白无反应是KD患儿并发冠状动脉病变的高危因素，应加强对上述因素的干预。

Abstract:
ObjectiveTo explore the laboratory examination and analysis of Kawasaki disease(KD) complicated with Mycoplasma pneumoniae infection and the risk factors of coronary artery disease.
MethodsNinety-two children with KD were divided into the observation group and control group according to their Mycoplasma pneumoniae infection.Blood C reactive protein (CRP), erythrocyte sedimentation rate (ESR), aspartate aminotransferase (AST), creatine kinase isoenzyme (CK-MB), procalcitonin (PCT), hemoglobin (HB), serum immunoglobulin (Ig) and complement were detected and analyzed.According to the presence or absence of coronary artery disease, the children were divided into the coronary artery disease group and non coronary artery disease group, and the relevant factors were selected for logistic regression analysis.
ResultsAmong 92 children with KD, 48 cases(52.2%) were complicated with Mycoplasma pneumoniae infection.CRP, ESR, PCT, IgG and C3 in the observation group were higher than those in the control group(P<0.05 to P<0.01).Sex, fever time, Hb, ESR, Mycoplasma pneumoniae infection and non response to γ-globulin were closely related to coronary artery disease in children with KD (P<0.05 to P<0.01).Multivariate logistic regression analysis showed that the independent risk factors of KD children complicated with coronary artery disease were fever time≥7 d (OR=3.229, P<0.01), Hb<100 g/L(OR=2.114, P<0.05), Mycoplasma pneumoniae infection(OR=3.356, P<0.01), and no response to γ-globulin (OR=3.655, P<0.01).
ConclusionsMycoplasma pneumoniae infection may be one of the causes of KD.There was a positive correlation between KD complicated with Mycoplasma pneumoniae infection and CRP, ESR, PCT, IgG and C3 in patients with KD.Fever time≥7 d, Hb<100 g/L, Mycoplasma pneumoniae infection and non response to γ-gamma globulin are the high-risk factors of KD children complicated with coronary artery disease.The intervention of these factors should be strengthened.

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