Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Comparison of Cervical-lymph-node-first Presentation of Kawasaki Disease and Typical Kawasaki Disease

전형적인 가와사키병 환아와 경부 림프절종대를 주소로 내원하여 가와사키병으로 진단된 환아의 비교

  • Yun, Hye-Won (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Jun-Yeol (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Yang, Song-I (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Yu, Hee-Joon (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kang, Min-Jae (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, So-Yeon (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Hae-Ran (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Kwang-Nam (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Sung-Hye (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
  • 윤혜원 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 이준열 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 양송이 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 유희준 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 강민재 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 이소연 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 이혜란 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 김광남 (한림대학교 의과대학 한림대학교성심병원 소아과학교실) ;
  • 김성혜 (한림대학교 의과대학 한림대학교성심병원 소아과학교실)
  • Received : 2015.08.11
  • Accepted : 2015.10.17
  • Published : 2016.04.25
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Abstract

Purpose: The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease. Methods: We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed. Results: The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08). Conclusions: The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.

목적: 가와사키병은 임상적인 증상에 의존하여 진단하므로 조기진단이 어려우며 특히 경부 림프절종대만을 주소로 내원할 경우 가와사키병의 진단에 어려움을 줄 수 있다. 본 연구는 전형적인 양상의 가와사키병 환아와 발열과 경부 림프절종대를 주 증상으로 내원한 가와사키병 환아에서의 임상적 차이와 진단의 지연 및 관상동맥 합병증과의 연관성을 확인하고자 하였다. 방법: 2012년 1월부터 2014년 12월까지 한림대학교성심병원에 가와사키병으로 입원한 환자 중 전형적인 임상증상으로 내원하여 가와사키병으로 진단받은 259명을 대조군(KD 군)으로, 발열과 경부 림프절종대를 주 증상으로 내원하여 가와사키병으로 진단받은 24명을 환자군(LKD 군)으로 정하여 후향적으로 조사하였다. 결과: LKD 군의 평균연령은 40개월로 KD 군의 28개월보다 높았다(P=0.04). 발열부터 가와사키병으로 진단받고 정맥용 면역글로불린 치료를 하기까지의 기간은 LKD 군에서 KD 군에 비해 더 길었다(P<0.001). 발열을 제외한 다섯 가지 임상 증상 중 LKD 군에서는 평균 1.62개, KD 군에서는 평균 3.47개의 증상을 보여 통계적으로 유의한 차이를 보였다(P<0.001). LKD 군에서 혈액검사 상 C-반응단백이 KD 군에 비해 높았다(P=0.01). 진단 2주 이내와 2개월 이내에 시행한 심장 초음파 검사에서 관상동맥 합병증 발병률은 두 군에서 차이가 없었다(P=0.52, P=0.08). 결론: 발열과 경부 림프절종대를 주 증상으로 내원하는 경우 가와사키병의 임상양상이 뚜렷하지 않아 초기에 진단하기 어려우므로 진단이 지연되지 않도록 환자 진찰 시 세심한 관찰이 필요하다.

Keywords

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