川崎病住院患儿心血管疾病的临床特点、结局及危险因素

A. K. A. A. K. Al-Miraj, S. M. R. S. M. Rezwanuzzaman, Sakera Khatun Mony Sakera Khatun Mony, Muhammad Abduz Zaher Muhammad Abduz Zaher, Md. Rezaul Alam Md. Rezaul Alam, Mohammad Ata Ullah Mohammad Ata Ullah, Sharmin Akter Sharmin Akter, Mohammad Maruf Reza Mohammad Maruf Reza
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摘要

川崎病(KD),又称川崎综合征,是一种病因不明的急性发热性疾病,主要影响5岁以下儿童。本研究旨在探讨儿童川崎病的临床特点、预后及危险因素。这项观察性前瞻性研究于2020年6月1日至2021年7月31日在孟加拉国达卡Bangabandhu Sheikh Mujib医科大学医院诊断为川崎病的心脏病病房进行。研究对象为45名年龄在3个月至10岁之间的儿童。川崎病以男童多见(73.33%)。最常见的心血管累及危险因素,特别是冠状动脉扩张或动脉瘤改变,在年轻时更容易观察到。发热、皮疹、结膜炎、四肢红斑水肿、趾周皮肤脱屑是主要表现。左主干冠状动脉扩张累及心血管是研究人群中最常见的动脉瘤改变,68%的儿童有冠状动脉累及。所有患者均接受大剂量阿司匹林治疗(100%),93%的患者接受IVIG治疗,其中6.66%的患者存在IVIG抵抗性川崎病。常见的并发症是葡萄膜炎(17.77%)。在45例研究人群中,1例患者死亡(2.22%)。临床医生对持续发热患者应高度怀疑川崎病,一旦临床确诊,应进行超声心动图检查,并开始IVIG联合阿司匹林治疗,特别是婴儿(<6个月),因为他们更容易发生冠状动脉瘤。
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Clinical Profile and Outcome and Risk Factors of Cardiovascular Involvement in Hospitalized Children with Kawasaki Disease
Kawasaki disease (KD), also known as Kawasaki syndrome, is an acute febrile illness of unknown cause that primarily affects children younger than 5 years of age. The present study was conducted to study the clinical profile and outcome and risk factors of Kawasaki disease in children. This observational prospective study was conducted in cardiology ward with a diagnosis of Kawasaki disease from 1st June 2020 to 31 July 2021 in Bangabandhu Sheikh Mujib Medical University Hospital Dhaka, Bangladesh. Forty five (45) children aged between 3 months to 10 years were studied. Kawasaki disease is more prevalent among male child (73.33%). Most commonly encountered risk factor for cardiovascular involvement especially coronary dilatation or aneurysmal change is more observed in younger age of presentation. Fever, rash, conjunctivitis, erythema and edema of limbs, periungual skin desquamations are the presenting features. Cardiovascular involvement of left main coronary artery dilation is the most frequently observed aneurismal change observed among study population which was evident in 68% of the children having coronary involvement. All the study patient received high dose aspirin (100%) and 93% received IVIG of whom 6.66% had IVIG- resistant Kawasaki disease. Commonly occurring complication is uveitis (17.77%). Among the total 45 study population 1 patient expired (2.22%).Clinicians should have a high index of suspicion of Kawasaki disease in persistently febrile patients and once clinically diagnosed, echocardiography should be done and IVIG therapy along with aspirin should be started, specially in infants (<6 months) as they have the higher tendency to develop coronary aneurysm.
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