Clinical Observation of Mucocutaneous Lymph Node Syndrome

川崎病的臨床所見

楊宏義(Horng-Yih Yang) ； 林季珍(Ghi-Jen Lin) ； 李慶雲(Chin-Yun Lee) ； 呂鴻基(Hung-Chi Lue)

《Acta Paediatrica Sinica》 26卷3期 (1985/06) Pp. 213-222

摘要

1976年臺大醫院小兒科首先發現了臺灣第一例川崎病，從那時候起，7年當中（1976年3月至1983年7）一共收集了46個病例。其中男與女的比例為1.6比1年齡分佈由4個月到8歲，最好發的年齡在1歲至2歲間，發病的季節並無特殊的趨向，但秋季似乎較少發生。在1983年 1月至1983年9月的流行期間內，一共有21個病例。其臨床主要特徵包括發燒(100%)，結膜炎(93.5%)，頸部淋巴腫大(33.3%)，嘴、唇病變(100%)－口腔黏膜泛紅(97.6%)，嘴唇發紅，(山虖)裂，或結痂(90.7%)，草莓樣舌頭(73.8%)，皮膚出疹(91.1%)，四肢的病變(95.6%)－掌蹠硬性浮腫(72.1%)，泛紅(72.7%)，脫屑(87%)。其他的徵兆包括鼻炎或咳嗽(45.9%)，腹瀉(24.3%)，肛門周圍泛紅或脫屑(75.6%)，關節炎(15.2%)，膽囊水腫(50%)。實驗室檢查結果，在急性期CRP出現，ESR增加，白血球升高的比例分別為83.3%，86.2%，及71.9%，血小板在急性期只有43.5%的病例增高，但是到亞急性期則有73.9%的病例增高，血清白蛋白降低的病例有23.1%(9/39)，其中5例併發冠狀動脈病變，比率高達62.5%，比正常血清白蛋白的病例有罹患冠狀動脈病變的比率13.3%(2/15)顯然高出許多(P=0.024)。心電圖有變化的病例佔81.4%，7例ST-T變化中的5例發生冠狀動脈病變。24例接受心臟超音波、心導管檢查，8例(33.3%)有冠狀動脈病變，其中男孩7例，女孩1例。其他的特徵包括肝炎(26.8%)，無菌性腦膜炎(6.5%)，膿尿(20%)，血尿(9.7%)，蛋白尿(16.1%)，肺紋裡增加(25.7%), 肺浸潤(5.7%)。

並列摘要

Between March 1976 and July 1983, a total of 46 cases of mucocutaneous lymph node syndrome (MCLS) were encountered in the National Taiwan University Hospital. Twenty-eight were male and 18, female, with a sex ratio of 1.6. Their ages ranged from four months to eight years with a peak between one and two years. MCLS occurred in any month of the year, but there was an epidemic of 21 cases between January and September, 1983. Salient manifestations included fever (100%), conjunctivitis (93.5%), cervical lymphadenopathy (33.3%), oropharyngeal erythema (97.6%), red lips with fissure or crust (90.7%), strawberry tongue (73.8%), skin rash (91.1%), indurated edema of the hands and feet (72.1%), erythema of palms and soles (72.7%), desquamation of digiis (87%). Associated features included coryza or cough (45.95%), diarrhea (24.3%), perianal erythema or desquamation (75.6%), arthritis (15.2%), and hydrops of gallbladder (50%). Acute phase reactants, CRP, ESR, and/or leukocytosis, were noted in 72 to 86% of the cases. Thrombocytosis was observed in 43.5% and 73.9% of the cases in the acute and subacute stage, respectively. Hypoalbuminemia occurred in eight cases; among them five (62.5%) had coronary changes compared with only 2 (13.3%) of 15 at the normal level (P=0.024). EKG changes were noted in 81.4% of the cases. Among the 24 cases studied by echocardiography and/or angiocardiography, 8 (33.3%) showed coronary changes. The other laboratory findings included hepatitis (26.8%), aseptic meningitis (6.5%), pyuria (20%), hematuria (9.7%), proteinuria (16.1%), increased lung markings (25.7%), and pulmonary infiltrations (5.7%).

並列關鍵字

Kawasaki disease ； mucocutaneous lymph node syndrome ； coronary artery lesions ； aneurysms