摘要
目的总结婴儿期发病的多发性大动脉炎(Takayasu arteritis,TA)的临床特点及诊断方法。方法选取2014年1月至2019年12月以感染性疾病收入首都医科大学附属北京儿童医院并确诊为TA的患儿10例,分析总结其临床特点及诊断方法。结果10例婴儿中,男4例,女6例,男女比1∶1.5;发病年龄1个月21 d至4个月;入院后至确诊时间平均(9.7±6.4)d。10例患儿均有发热;病程中出现血压升高6例,伴有呼吸道症状5例,神经系统症状4例,消化道症状3例,皮疹3例。实验室检查:确诊前WBC(7.23~22.17)×10^(9)/L,平均(12.8±4.2)×10^(9)/L;CRP 8~123 mg/L;动态ESR34~117 mm/h;降钙素原(procalcitonin,PCT)0.17~0.60 ng/ml。血管超声提示受累血管为,颈动脉(10/10)、腹主动脉(9/10)、肾动脉(7/10)、肠系膜上动脉(9/10)、上肢动脉(6/9)、下肢动脉(2/7)、冠状动脉(4/10),后均经增强CT检查确诊。无感染性疾病证据。结论婴儿TA罕见,早期仅表现为发热,血管受累的临床症状不典型,易误诊。若小婴儿表现为发热,但感染症状不明显且无感染病灶,炎症指标明显升高,但与体温不相平行时,应注意TA的可能。血管超声有助于早期诊断。
Objective To summarize the clinical characteristics and diagnosis of Takayasu arteritis(TA)with infantile onset so as to provide clinical experience and theoretical basis for early diagnosis.Methods The clinical characteristics and diagnosis were analyzed and summarized for 10 infants who were admitted to Beijing Children’s Hospital between 2014 and2019 due to suspected infectious diseases and were finally diagnosed with TA.Results Among 10 infants,four were boys,and six were girls.The age of onset ranged from one month and 21 days to four months.The average time from admission to diagnosis was(9.7±6.4)days.All of the ten infants had a fever.During the course of the disease,six cases had elevated blood pressure,and five cases had respiratory symptoms.There were four cases had symptoms of nervous system,three cases with gastrointestinal symptoms and three cases with skin rash.As for laboratory examination,blood routine test before diagnosis showed that,one week after body temperature stabilized,the count of WBC was(7.23-22.17)×10^(9)/L,with an average of(12.8±4.2)×10^(9)/L,CRP was 8-123 mg/L.The erythrocyte sedimentation rate(ESR)was 34-117 mm/h.Procalcitonin(PCT)was 0.17-0.60 ng/ml.Ultrasound examination of blood vessels revealed affected blood vessels were carotid artery(10/10),abdominal aorta(9/10),renal artery(7/10),superior mesenteric artery(9/10),upper limb artery(6/9),lower extremity arteries(2/7)and coronary arteries(4/10).All cases were confirmed by enhanced CT.All infants had no evidence of infectious disease.Conclusions TA in infant,which has a rare occurrence,is accompanied by fever that develops only in the early stages,and atypical and easily misdiagnosed clinical symptoms of affected vessels.In infants with fever,when no infected focuses and obvious infected symptoms can be found,and the inflammatory factor is significantly increased but not parallel to the body temperature,TA should be considered.Vascular ultrasound may be beneficial for early diagnosis.
作者
胡冰
陈天明
郭凌云
胡惠丽
郭欣
刘钢
Hu Bing;Chen Tianming;Guo Lingyun;Hu Huili;Guo Xin;Liu Gang(Department of Infectious Disease,Beij ing Children 5 Hospital,Capital Medical University,Beijing 100045,China)
出处
《北京医学》
CAS
2021年第8期756-760,共5页
Beijing Medical Journal
关键词
多发性大动脉炎
超声
婴儿
Takayasu arteritis(TA)
ultrasound
infant
