儿童川崎病与关节炎关系的研究进展

摘要

儿童川崎病(Kawasaki disease,KD)或不典型川崎病(incomplete Kawasaki disease,IKD)是一种以全身血管炎病变为主要病理特征的疾病,临床主要表现为无明显诱因的发热,伴有皮肤黏膜及淋巴结的损害.由于本病常伴有严重的心血管并发症如冠状动脉瘤,故引起人们的重视.但由于约三分之一患儿可伴有关节炎或关节痛,早期不易与幼年特发性关节炎区别,尤其是与全身型幼年特发性关节炎(sys-temic-onset juvenile idiopathic arthritis,SoJIA)的早期区分困难.KD和SoJIA是对于儿童长期发热、皮疹、淋巴结肿大的不同诊断,诊疗程序也截然不同,但在早期临床诊断上完全区分两者是很困难的,尤其是IKD和早期SoJIA.故该文对KD与关节炎的关系作一综述,旨在提醒临床医生重视KD与IKD的诊断,以免延误治疗.%Kawasakd disease(KD) or incomplete KD(IKD) is a systemic vasculitis predominantly affecting young children.Clinical manifestations include fever with no obvious origin,skin damage,abnormalities of mucous membrane and lymph nodes.The disease is often accompanied by serious cardiovascular complications such as coronary artery aneurysm,therefore it attracts more and more attention.But arthritis or arthralgia complicates over one-third of KD or IKD patients.So early-onset arthritis is often indistinguishable from early juvenile idiopathic arthritis,especially systemic-onset juvenile idiopathic arthritis(SoJIA).KD and SoJIA are considered to be different diagnoses for children with long-term fever,rash,swollen lymph nodes,and more importantly,the treatment procedures are very different,but it is difficult to completely distinguish the two diseases,especially the IKD and early SoJIA.So in this paper,we will summarize the relationship between KD and arthritis in children,which aims to remind clinicians to pay attention for the diagnosis of KD and IKD.We suggest that physicians should be alert of the fact that they must individualize every patient's management,rather than merely care by the guidelines,which will delay the treatment.