非川崎病发热性疾病致冠状动脉瘤2例并文献分析

doi:10.20047/j.issn1673-7210.2023.18.37

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摘要川崎病并非导致儿童冠状动脉病变（CAL）的唯一疾病，多发性大动脉炎（TA）、幼年特发性关节炎全身型（SOJIA）等疾病亦可累及冠状动脉，临床相对少见而易漏/误诊。本文报道1例发热伴冠状动脉瘤（CAA）患者，人免疫球蛋白（IVIG）治疗效果不佳，诊治过程中发现血压高、锁骨下动脉狭窄及腋动脉瘤，最终诊断为TA，给予激素、甲氨蝶呤、托珠单抗治疗后缓解。本文还报道1例SOJIA患者，主因发热、CAA入院，IVIG疗效欠佳，后出现皮疹、多关节积液（髋、膝、肩关节），诊断为SOJIA。给予萘普生片、激素、托珠单抗治疗后好转。本文回顾性分析2例非川崎病发热性疾病致CAA的临床特点，以提高临床医师对致儿童CAL相关疾病的认识。

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	王莹雪1　　陈敬师1　　贾雨涵2　　郑雨濛2　　张英谦1▲

关键词 ：冠状动脉瘤, 非川崎病发热性疾病, 川崎病, 儿童

Abstract：Kawasaki disease is not the only disease that causes coronary artery lesions (CAL) in children. Takayasu arteritis (TA) and systemic onset juvenile idiopathic arthritis (SOJIA) can also involve coronary arteries, which are relatively rare in clinic and easy to miss/misdiagnose. This paper reports a case of fever with coronary artery aneurysm (CAA) who was not well treated with intravenous immunogloblin (IVIG). High blood pressure, subclavian artery stenosis, and axillary artery aneurysm were found in the course of diagnosis and treatment. TA was finally diagnosed and relieved after treatment with Prednisone, Methotrexate, and Tocilizumab. This paper also reports a patient with SOJIA, who was hospitalized mainly due to fever and CAA. The efficacy of IVIG was poor, and then rash and multiple joint effusion (hip, knee, and shoulder joints) occurred. The patient was diagnosed as SOJIA and improved after treatment with Naproxen Tablets, Hormones and Tocilizumab. This article retrospectively reviewed the clinical features of two cases of CAA caused by non-Kawasaki disease febrile disease, in order to improve the understanding of clinical doctors of the diseases related to CAL in children.

Key words： Coronary artery aneurysm Non-Kawasaki disease febrile illness Kawasaki disease Children

基金资助:河北省重点研发计划项目（18277708D）。

通讯作者: ▲通讯作者

引用本文:

王莹雪1　　陈敬师1　　贾雨涵2　　郑雨濛2　　张英谦1▲. 非川崎病发热性疾病致冠状动脉瘤2例并文献分析[J]. 中国医药导报, 2023, 20(18): 164-168,173.
WANG Yingxue1 CHEN Jingshi1 JIA Yuhan2 ZHENG Yumeng2 ZHANG Yingqian1▲. Non-Kawasaki disease febrile illness complicated coronary artery aneurysm in two cases and the literature review. 中国医药导报, 2023, 20(18): 164-168,173.

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