重庆市川崎病流行病学调查研究
摘要
背景：川崎病（Kawasaki disease,KD）是儿科常见的后天性心血管疾病之一，是一种好发于儿童，免疫介导的全身性自限性血管炎性疾病，全身各个脏器均可受累，以心脏及冠状动脉病变最为严重，可并发全心炎，20~25%可形成CAA，亦可发生冠状动脉狭窄、闭塞及冠状动脉粥样硬化、甚至血栓栓塞；少数患儿遗留缺血性心脏病，主要死亡原因为急性心力衰竭、CAA破裂、严重心律失常以及急性心肌梗塞。日本川崎富作于1961年发现首例KD病人，1967年首次报道50例病例；自1970年开始，世界上其他国家及地区陆续有报道并相继作了流行病学调查；目前KD病因尚不完全清楚，从其表现为发热，皮疹以及发病有地区性，季节性的特点推测其发病与感染有关。为明确病因，日本国KD研究中心每两年进行1次KD流行病学调查，迄今为止已进行了16次，调查显示日本KD发病率居世界之首 ；我国于1976年发现首例KD患儿，近年来国内儿科界发现KD病例逐年增多，我国部分省市和地区如北京、哈尔滨、陕西、香港等已进行过KD流行病学调查等，而上述地区的流行病学调查结果也不尽相同；重庆市目前尚未进行过类似的调查，缺少KD在本地区发病的流行病学相关资料。
目的：通过对1997~2001年诊断为KD的住院患儿进行登记调查，
了解重庆市KD的实际发病情况、分布及流行病学现状。
对象方法：根据日本国KD研究中心提供的第7届东京KD国际会议制定的KD诊断标准来制定统一的ＫＤ流行病学调查表，对全市有儿科病床的120家综合医院和专科医院联合调查，选择1997年1月-2001年12月儿科住院的1100例KD初诊患儿进行登记调查。
结果：（1）返回调查表116份，调查表回收率为96.67%。（2）5年中，重庆市KD总病例数为1100例，其中男687例，女413例男女之比为1.66:1。（3）发病季节高峰为每年的3~7月。（4）3岁以下患儿占61.17%，发病高峰年龄在3岁以下，1~2岁之间KD发病率最高为20.51/10万；1997~2001年５岁以下儿童KD发病率在7.97~30.48/10万之间。（5）未发现死亡病例，死亡率为0。（6）发生冠状动脉并发症病例共105例,占总病例数的9.54%，其中男69例，女36例，男女之比为1.92:１，重庆市KD患儿冠状动脉并发症发生率为：1岁以下14.44%、1~2岁7.32%、2~3岁7.83%、3~4岁9.03%、4~5岁9.41%，年龄越小越易发生冠状动脉后遗症，1岁以下年龄组冠状动脉后遗症发生率最高，为14.44%。（7）就诊日期多分布在发病后4~7天，占72.27%（8）病例来自城市为753例（68.45%），来自农村为病例347例（31.55%）。
结论：KD在重庆地区是儿童较常见疾病，城市发病较农村高，发病季节主要在3-7月，3岁以下年龄为发病高峰，年龄越小，越易发生冠状动脉后遗症。提示KD为引起儿童后天性心血管疾病的主要原因
之一，应提高广大基层医生对该病的认识，做到早期诊断和治疗，对降低该病的发病率及死亡率至关重要。
Background: KD is an acute febrile illness with multisystem vasculitis of infancy and early childhood-onset that is associated with myocarditis and coronary artery abnormalities. Despite the widely held belief that KD is caused by an infection agent or is an autoimmune response to an infection agent, considerable controversy remains over its aetiology. Most authors now think that KD is now one of the most common causes of cardiovascular acquired disease. First case of KD was found by Dr Tomisaku Kawasaki in Japan in1961, and then he first reported 50 KD patients in 1967.There are also KD patients reported in other country and region.Toidentify the aetiology of KD, epidemiologic survey of KD was carried out by Kawaski Disease Research Committee in Japan every two years. Up to now, the epidemiologic surveys have been conducted 16 times inJapan. The investigation suggests that the incidence rate be highest in
Japan. Among the world the first case of KD was reported in China in 1976, and then there are more and more KD patients found in our country during these years. The epidemiologic survey of KD has been conducted in a few of provinces and metropolitans in our country, such as Beijing, Shanxi province, Harbin, Hongkong, et al. The epidemiologic survey has not been conducted in Chongqing; the incident rate of KD is higher in these cities near Yangtz River, like Chongqing, than that of other cities in China, so it is emergency to have epide-characteristics of KD in Chongqing.
Objective：Objective of this paper is to describe the epidemiological and clinical characteristics of Kawasaki disease (KD) in Chongqing district of China during a 5-year-periord from January 1997 to December 2001.
Methods：A metropolitan-wide epidemiological survey on KD was carried out by China-Japan Kawasaki disease study group. The questionaire form and the diagnostic criteria of KD were prepared by the group and translated into Chinese, and sent to 120 hospitals with pediatric ward. All patients, meeting the KD diagnostic criteria of Japan Kawasaki Disease Research Committee during the period from 1997 to 2001, were involved .
Results： (1)A total of 116 hospitals responded and there are 1100 cases of KD in the 5 years in Changing area, 61.17% patients were under 3 years old and the ratio of male to female is 1.66; (2)The proportion of patients with cardiac sequelae, mainly coronary artery dilated and
aneurysm, was 9.52% and the ratio of male to female is 1.92; (3) The incidence rate is the highest in the children with KD between 1 year and 2 years.(4) There is no death reported during the period; (5) There are more KD patients in March to July than that of other months. (6)The patients mainly distributed in urban areas.
Conclusion：There are more KD patients found in urban that of in Chongqing. The cardiac sequelae of KD took place mainly in young children, so it’s one of common causes of acquired cardiovascular disease in children in our country. It is important to maintain high wareness of KD, diagnosis and treatment as early as possible to reduce the incidence and cardiovaslar complications.
目的：通过对1997~2001年诊断为KD的住院患儿进行登记调查，
了解重庆市KD的实际发病情况、分布及流行病学现状。
对象方法：根据日本国KD研究中心提供的第7届东京KD国际会议制定的KD诊断标准来制定统一的ＫＤ流行病学调查表，对全市有儿科病床的120家综合医院和专科医院联合调查，选择1997年1月-2001年12月儿科住院的1100例KD初诊患儿进行登记调查。
结果：（1）返回调查表116份，调查表回收率为96.67%。（2）5年中，重庆市KD总病例数为1100例，其中男687例，女413例男女之比为1.66:1。（3）发病季节高峰为每年的3~7月。（4）3岁以下患儿占61.17%，发病高峰年龄在3岁以下，1~2岁之间KD发病率最高为20.51/10万；1997~2001年５岁以下儿童KD发病率在7.97~30.48/10万之间。（5）未发现死亡病例，死亡率为0。（6）发生冠状动脉并发症病例共105例,占总病例数的9.54%，其中男69例，女36例，男女之比为1.92:１，重庆市KD患儿冠状动脉并发症发生率为：1岁以下14.44%、1~2岁7.32%、2~3岁7.83%、3~4岁9.03%、4~5岁9.41%，年龄越小越易发生冠状动脉后遗症，1岁以下年龄组冠状动脉后遗症发生率最高，为14.44%。（7）就诊日期多分布在发病后4~7天，占72.27%（8）病例来自城市为753例（68.45%），来自农村为病例347例（31.55%）。
结论：KD在重庆地区是儿童较常见疾病，城市发病较农村高，发病季节主要在3-7月，3岁以下年龄为发病高峰，年龄越小，越易发生冠状动脉后遗症。提示KD为引起儿童后天性心血管疾病的主要原因
之一，应提高广大基层医生对该病的认识，做到早期诊断和治疗，对降低该病的发病率及死亡率至关重要。
Background: KD is an acute febrile illness with multisystem vasculitis of infancy and early childhood-onset that is associated with myocarditis and coronary artery abnormalities. Despite the widely held belief that KD is caused by an infection agent or is an autoimmune response to an infection agent, considerable controversy remains over its aetiology. Most authors now think that KD is now one of the most common causes of cardiovascular acquired disease. First case of KD was found by Dr Tomisaku Kawasaki in Japan in1961, and then he first reported 50 KD patients in 1967.There are also KD patients reported in other country and region.Toidentify the aetiology of KD, epidemiologic survey of KD was carried out by Kawaski Disease Research Committee in Japan every two years. Up to now, the epidemiologic surveys have been conducted 16 times inJapan. The investigation suggests that the incidence rate be highest in
Japan. Among the world the first case of KD was reported in China in 1976, and then there are more and more KD patients found in our country during these years. The epidemiologic survey of KD has been conducted in a few of provinces and metropolitans in our country, such as Beijing, Shanxi province, Harbin, Hongkong, et al. The epidemiologic survey has not been conducted in Chongqing; the incident rate of KD is higher in these cities near Yangtz River, like Chongqing, than that of other cities in China, so it is emergency to have epide-characteristics of KD in Chongqing.
Objective：Objective of this paper is to describe the epidemiological and clinical characteristics of Kawasaki disease (KD) in Chongqing district of China during a 5-year-periord from January 1997 to December 2001.
Methods：A metropolitan-wide epidemiological survey on KD was carried out by China-Japan Kawasaki disease study group. The questionaire form and the diagnostic criteria of KD were prepared by the group and translated into Chinese, and sent to 120 hospitals with pediatric ward. All patients, meeting the KD diagnostic criteria of Japan Kawasaki Disease Research Committee during the period from 1997 to 2001, were involved .
Results： (1)A total of 116 hospitals responded and there are 1100 cases of KD in the 5 years in Changing area, 61.17% patients were under 3 years old and the ratio of male to female is 1.66; (2)The proportion of patients with cardiac sequelae, mainly coronary artery dilated and
aneurysm, was 9.52% and the ratio of male to female is 1.92; (3) The incidence rate is the highest in the children with KD between 1 year and 2 years.(4) There is no death reported during the period; (5) There are more KD patients in March to July than that of other months. (6)The patients mainly distributed in urban areas.
Conclusion：There are more KD patients found in urban that of in Chongqing. The cardiac sequelae of KD took place mainly in young children, so it’s one of common causes of acquired cardiovascular disease in children in our country. It is important to maintain high wareness of KD, diagnosis and treatment as early as possible to reduce the incidence and cardiovaslar complications.
引文
Kawasaki disease:Clinical characteristics and cardiovascular in involvement in acohort of 121 patients. Pediatr Med chir.2002 (Sep-Oct) 24(5):352-7;discussion 397~399
Tuber KA,AH Rowley,and ST Shulman. A 10 year (1984-1993) United States hospital survey of Kawasaki disease. In H. Kato (ed).1995;50:34~38.
Rolyle JA, Williams.K.kawasaki disease in Australia 1993-1995 Arch Dischild. 1998. 78:33～35
Leung, DYM,HC Eisner,DR Fulton,DL Murray,BL Kotzin,and PM Schlievert..Toxic shock syndrome toxin-secreting Staphylococcus aurous in Kawasaki syndrome.Lancet.1993.342:1385~1388
Akiyama T,Yashior K.Probable role of streptococcus pyogenes in Kawasaki disease. Eur J Pediatr.1993;152:82~92
Curtis N,Zheng R,Lamb JR,Levin M.Evidence for a superantigen mediated process in Kawasaki disease. Arch Dis Child.1995;72:308~311.
Leung DYM, Meissner HC, Shulman ST, et al.Prevalence of superantigen-secreting bacteria in patients with Kawasaki disease. J Pediatr.2002;140:742~746.
Abe J,Kotzin BL,Jujo K,et al. Selective expansion of T cell expressing T-cell receptor viariable regions V beta 2 and V beta 8 in Kawasaki disease [J]. Proc Natl Sci USA. 1992;89(9):4066~4070
Yoshioka T,Matsutani,Iwagami S, et al . Polyclonal expansion of TCR-V beta 6 and TCR-V beta 8-bearing T cells in patients with Kawasaki disease [J]. Immunology. 1999;9693:465~472
Abe J,Kotzin BL,Meissner C,Melish ME,Masato T,Fuluton D,Romagne F,Malissen B,Leung DYM.Characterization of T cell repertoire changes in acute Kawasaki disease. J Exp Med.1993;177:791~796
Choi Y,Lafferty JA,Clements JR,Todd JK,Gelfand EW,Kappler J,Marrack P, Kotzin BL.Selective expansion of T cells expressing V beta 2 in toxic shock syndrome. J Exp Med . 1990; 172:981~984
Pietra BA,De Inocencio J,Giannini EH, et al. TCR V beta family receptoire and T cell activation markers in Kawasaki disease [J]. J Immunol.1994;153(4):1881~1888
Abe J,Kiting BL,Juju K,et al .Selective expansion of T cells expressing T-cell receptor viariable regions V beta 2 and V beta 8 in kawasaki disease [J].Proc Natal Sci USA. 1992; 89(9):4066~4070
Abe J,Kotzin BL,Jujo K,Melish ME,Glode MP,Kohsaka T,Leung DYM Selective expansion of T cells expressing T-cell receptor variable regions V beta 2 and V beta 8 in Kawasaki disease. Proc Natl Acad Sci USA. 1992;89:4066~4070
Rowly AH,Shulman ST,Mask CA,Baker SC. Oligoclonal in the vascular wall in acute Kawasaki disease. Pediatr Res. 2000;47:20~21.
Choi IH, Chwae YJ, Shim WS, et al. Clonal expansion of CD8+T cells in Kawasaki disease [J].J Immunol. 1997;159(1):481~486
Rowley SH. The etiology of Kawasaki disease: superantigen or conventional antigen [J]. Pediatr Infect Dis J.1999;18:69~70
Meissner HC,Leung DY.Superantigens, conventional antigens and the etiology of Kawasaki syndrome [J].Pediatr Infect Dis J.2000;19:91~94
Kawasaki,T Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Jpn.J. Allergy. 1967; 16:178~222.
Hiroshi Yanagawa,Mayumi,Izumi Oki,Yosikazu Nakamura,Tuohong Zhang Thirty- Year-obseavation of the incidence rate of Kawasaki in Japan. Pediatric Research. 2003 January ; 53(1):158~160.
Yanagawa H,Nakammray,yashirom, et al. Results of the nationwide epidemiologic survey of kawasaki disease in 1995 and 1996 in Japan .Pediatric. 1998.102:65~70
Zhang T, Yanagawa. H, Nakamura Y. The profile of Kawasaki disease in China. J Epidemio. 2001 May ;11(3):103~108
周永昌主编，超声医学，第2版，科学技术出版社，476~478
吴瑞萍，胡亚美，江载芳主编。诸福棠实用儿科学［M］。北京，人民卫生出版社，第6版；1997：689~690。
刘亚黎。川崎病的冠状动脉损害[J]。实用儿科临床杂志，2001；16（5）：337~338
梁翊常，王乃坤，1987-1991年78所医院川崎病患儿调查。临床儿科学杂志，
1994.12，319~322
Melish, ME,RM Hicks,and EJ.Larson.. Mucocutaneous lymph node syndrome in the United States.Am. J.Dis. Child. 1976;130:599~607
Newburger,Jane W,Taubert,Kathryn A.et al. Summary and Abstracts of the Seventh International Kawasaki Disease Symposium:Japan International Pediatrics Research Foundation Volume 53(1)；2003 January;153~157
Lee,DB.pidemiologic survey of Kawasaki syndrome in Korea (1976-1984). J. Cathol. Med. Coll.1985;38:13~19
Salo E,Pelkonen P,Pettay O,et al.Outbreak of Kawasaki Syndrome in Finland. Acta P?diatric Scand. 1986 Jan;75(1):75~80
Chang RK. Hospitalizations for Kawasaki disease among children in the United States,1988-1997. Pediatrics.Jun , 2002;109(6):e87
HC Lue,S Philip.Kawasaki Disease in Taiwan: A 4th Nationwide Survey,1994-2000 International Pediatrics Research Foundation Volume 53(1)；2003 January;159~160
王大为，江苏省流行病学调查。中华流行病学杂志，2000；4(21)：94~96
焦富勇，张拓红，陕西省川崎病流行病学调查研究。中华流行病学杂志，2000；4（21）：97~99
Du，Zhong_Dong MD,MPH. Zhang,Tuohong MD,Liang, Lu MD.Meng,xiaoping MD.Li,Tang MD.Kawasaki,Tomisaku MD.Nakamura,Yosikazu MD, MPH, Yanagawa Hiroshi MD. Epidemiologic picture of Kawasaki Disease in Beijing from 1995 through 1999.Pediatric Infections Disease Journal. February, 2002; 21(2): 103~107
Lijie Wu,Huiying Zhang,Yijun Wang et al.Epidemiological Survey of Kawasaki Disease during 1995-2000 in Harbin.International Pediatrics Research Foundation. Volume 53(1)；2003 January;167~168
Xiaoguang Zhou,Shuzhen Wang,et al.Epidemiologic Survey on Kawasaki Disease in South China, 1995-1999 International Pediatrics Research Foundation；Volume 53(1)；January 2003;167~168
Tsuchida,ST. Yamanaka,R.Tsuchida, Y. Nakamura,M Yashiro,and H.Yanagawa.. Epidemiology of infant Kawasaki disease with a report of the youngest neonatal case ever reported in Japan.Acta Pediatr.1996;85:995~997
Freeman,Alexandya F Shulman,Stanford T.Recent development in Kawasaki
Disease .Current opinion in infectous Disease .June 2001;14(3):357~361.
Shulman S,Melish N,Inoue O, et al.Immunoglobulin allotypic markers in Kawasaki Disease.J Pediatr.1993;122(1):497~502.
Anderson NS,Burns J, Treadull TA. Erythrocyte sedimentation rate and C-reactive protein discrepancy and high prevalence of coronary artery abnormalities in Kawasaki disease. Pediatr infect Dis J. .Jul ;2001;20(7):687~702.
Furukara S,Mafsubara T,Umezawa, et al.Serum levels solube tumor necrosis factor receptor during acute Kawasaki Disease [J]. J Pediatr.1994;124;721~725.
Yangawa H,Nakamura YUpdate of epidemiology of Kawasaki disease in Japan. J Epidemiology;1996;6(4):8~15
Hiro j,Hibi S,Andob T,et al.High levels of circulating interleukin-4 and interleukin-10 in Kawasaki disease. Int Arch Allergy immunol.1997;112:152~156.
王宏伟，程佩萱，鲁维伟。川崎病患儿冠状动脉病变发生机理及预防探讨。中华儿科杂志.1998；38：86~88.
Wang CR,Liu MR,Tshi RT,etal. Circulating intercellular adhesion molecules-1 and antibodies includinganti-endothelialcell , anti-cardiolopin and anti-neutrophil cytopasma antibodies in patients with vasculitis [J]. Clin Rheumatol. 1993; 12(3): 376~380.
Yonish-Rouach,Resnitiky D,Lotern J,et al.Wild-type P53 induces apoptosis of myeloid.Leukaemic cells that is inhibited by IL-6 [J].Nature.1991,352:345~347.
刘佳，李宏，Hamou MF,等。IL-6对小兽（杂交瘤） 7TD1细胞凋亡的调控作用[J].中华微生物和免疫学杂志，1995，15（6）：382~385
易岂建，杨锡强，李成荣。IL-6对急性川崎病患者外周血淋巴细胞凋亡影响。中华微生物和免疫学杂志，1998，18（1）：37~40
Furusho K, Kamiya T, Nakano H, Kiyosawa V, et al. High-dose intra venogammaglobulin for Kawasaki disease.Lancet.1984;2:1055~1058
Durongpisitkul K,Gururaj VJ,Park JM,et al.The prevention of coronary artery aneurysm in Kawasaki disease:a mata-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrils.1995;96(6):1057~1061.
Tse SM,Silverman ED,Mccrinadle BW,Yeung RS,Early treatment with intravenous immunoglobulin in patients with Kawasaki disease. J pediatr.2002 Apr; 140(4):
450~455.
Sundel RP.Update on the treatment of Kawasaki disease inchildren. Curr Rheumatol Rep. 2002 Dec;4(6):474~82
Yanagawa H Nakamuray,sakatam et al use of intraeuousr globulin for kawasaki disease effects on cardiac sequelae pediatric cardiol.1997.18 (1):19~23
Newburger JW Kawasaki disease Curr Treament options cardiovasc Med.2000 Jun; 2(3):227~236.
Newburger JW,Takahashi M,Burns JC,Beiser AS,Chung KJ, Duffy E, et al.The treatment of Kawasaki syndrome with intravenous gamme globulin. N Eng1 J Med 1986;315:341~347.
Saulsbury FT.Comparison of high-dose and low-dose aspirin plus intravenous immunoglobulin in the treatment of Kawasaki disease.Clin pediatr (Phila) . 2002 oct ; 41(8):597~601
Moran AM,Newburger JW, Sanders SP, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gamma-globulin.Am Heart. J 2000; 139: 217~223
李永柏, 易岂建, 李秋，等．优选静脉免疫球蛋白剂量治疗川崎病与免疫学效应研究[J]．中华儿科杂志，1999；37(2):97~100
Tsujimoto H,Takeshitu S,Nakatani k,et al.Intravenous immunoglobulin therapy induces neutrophil apoptosis in Kawasaki disease. Clin immunol 2002, 103(2): 161~168.
Yi QJ,Li CR,Yang XQ.Effect of intravenous immunoglobulin on inhibiting peripheral blood lymphocyte apoptosis in acute Kawasaki. Acta pediatr 2001: 90: 623~627.
kato H,Koke S,Yoko yama T Kawasaki disease: Effect of treatment of coronary artery involvement. Pediatr;1979;63(2):175~177.
Shinochara M,Sone K,Tomomasa T,et al.coricosteroids in the acute .kawasaki disease.[J] Pediatr;1999;135:465~469
Cremer H,Rieger C.Epidemiology of Kawasaki disease in Germany (FRG).Prog Clin Biol Res 1987;250:61~65.
Rowley AH,Shulman ST.Kawasaki syndrome [J]. Pediatr Clin North Am, 1999; 46;
313~325
Fulton DR,Newburger JW.Long-term cardiac sequlae of Kawasaki Disease .Curr Rheumatol Rep.2000 Aug;2(4):324~329
Fukunisbi M,Kikawa M,Hamana K, et,al .Pediction of non-responsiveness to intravenous high-dose r-globulin therapy in patients with Kawasaki disease at onset [J]. JPediatr, 2000; 137: 172~176
Sundel.RPJ,C.Burns,A.Baker,A.S.Beiser,and JW Newburger.Gamma globulin re-treatment in Kawasaki disease.J.Pediatr.1993;123:657~659
Wright.DA, JW. Newburger, A Baker, and RP Sundel, Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids. J.Pediatr. 1996; 128:146~149
Newburger JW,Takashi M,Beiser AS,et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Eng J Med1991;324:1633~1639.
Lee MS,An SY,Jang GC,Kim DS.A case of intravenous immunoglobulin-resistant Kawasaki disease treated with methotrexate,Yonsei Med J.2002 Aug; 43(4): 527~532.
Mori M, Imagawa T, Yamaguchi S, et al.Plasma exchange in Kawasaki disease. [J]. Drug. 1999; 58(5):813~822
Kato Hirohisa, Kawasaki disease 1st ed. Amsterdam Elsevier science BV，1995; 187~549
Tuber KA,AH Rowley,and ST Shulman. A 10 year (1984-1993) United States hospital survey of Kawasaki disease. In H. Kato (ed).1995;50:34~38.
Rolyle JA, Williams.K.kawasaki disease in Australia 1993-1995 Arch Dischild. 1998. 78:33～35
Leung, DYM,HC Eisner,DR Fulton,DL Murray,BL Kotzin,and PM Schlievert..Toxic shock syndrome toxin-secreting Staphylococcus aurous in Kawasaki syndrome.Lancet.1993.342:1385~1388
Akiyama T,Yashior K.Probable role of streptococcus pyogenes in Kawasaki disease. Eur J Pediatr.1993;152:82~92
Curtis N,Zheng R,Lamb JR,Levin M.Evidence for a superantigen mediated process in Kawasaki disease. Arch Dis Child.1995;72:308~311.
Leung DYM, Meissner HC, Shulman ST, et al.Prevalence of superantigen-secreting bacteria in patients with Kawasaki disease. J Pediatr.2002;140:742~746.
Abe J,Kotzin BL,Jujo K,et al. Selective expansion of T cell expressing T-cell receptor viariable regions V beta 2 and V beta 8 in Kawasaki disease [J]. Proc Natl Sci USA. 1992;89(9):4066~4070
Yoshioka T,Matsutani,Iwagami S, et al . Polyclonal expansion of TCR-V beta 6 and TCR-V beta 8-bearing T cells in patients with Kawasaki disease [J]. Immunology. 1999;9693:465~472
Abe J,Kotzin BL,Meissner C,Melish ME,Masato T,Fuluton D,Romagne F,Malissen B,Leung DYM.Characterization of T cell repertoire changes in acute Kawasaki disease. J Exp Med.1993;177:791~796
Choi Y,Lafferty JA,Clements JR,Todd JK,Gelfand EW,Kappler J,Marrack P, Kotzin BL.Selective expansion of T cells expressing V beta 2 in toxic shock syndrome. J Exp Med . 1990; 172:981~984
Pietra BA,De Inocencio J,Giannini EH, et al. TCR V beta family receptoire and T cell activation markers in Kawasaki disease [J]. J Immunol.1994;153(4):1881~1888
Abe J,Kiting BL,Juju K,et al .Selective expansion of T cells expressing T-cell receptor viariable regions V beta 2 and V beta 8 in kawasaki disease [J].Proc Natal Sci USA. 1992; 89(9):4066~4070
Abe J,Kotzin BL,Jujo K,Melish ME,Glode MP,Kohsaka T,Leung DYM Selective expansion of T cells expressing T-cell receptor variable regions V beta 2 and V beta 8 in Kawasaki disease. Proc Natl Acad Sci USA. 1992;89:4066~4070
Rowly AH,Shulman ST,Mask CA,Baker SC. Oligoclonal in the vascular wall in acute Kawasaki disease. Pediatr Res. 2000;47:20~21.
Choi IH, Chwae YJ, Shim WS, et al. Clonal expansion of CD8+T cells in Kawasaki disease [J].J Immunol. 1997;159(1):481~486
Rowley SH. The etiology of Kawasaki disease: superantigen or conventional antigen [J]. Pediatr Infect Dis J.1999;18:69~70
Meissner HC,Leung DY.Superantigens, conventional antigens and the etiology of Kawasaki syndrome [J].Pediatr Infect Dis J.2000;19:91~94
Kawasaki,T Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Jpn.J. Allergy. 1967; 16:178~222.
Hiroshi Yanagawa,Mayumi,Izumi Oki,Yosikazu Nakamura,Tuohong Zhang Thirty- Year-obseavation of the incidence rate of Kawasaki in Japan. Pediatric Research. 2003 January ; 53(1):158~160.
Yanagawa H,Nakammray,yashirom, et al. Results of the nationwide epidemiologic survey of kawasaki disease in 1995 and 1996 in Japan .Pediatric. 1998.102:65~70
Zhang T, Yanagawa. H, Nakamura Y. The profile of Kawasaki disease in China. J Epidemio. 2001 May ;11(3):103~108
周永昌主编，超声医学，第2版，科学技术出版社，476~478
吴瑞萍，胡亚美，江载芳主编。诸福棠实用儿科学［M］。北京，人民卫生出版社，第6版；1997：689~690。
刘亚黎。川崎病的冠状动脉损害[J]。实用儿科临床杂志，2001；16（5）：337~338
梁翊常，王乃坤，1987-1991年78所医院川崎病患儿调查。临床儿科学杂志，
1994.12，319~322
Melish, ME,RM Hicks,and EJ.Larson.. Mucocutaneous lymph node syndrome in the United States.Am. J.Dis. Child. 1976;130:599~607
Newburger,Jane W,Taubert,Kathryn A.et al. Summary and Abstracts of the Seventh International Kawasaki Disease Symposium:Japan International Pediatrics Research Foundation Volume 53(1)；2003 January;153~157
Lee,DB.pidemiologic survey of Kawasaki syndrome in Korea (1976-1984). J. Cathol. Med. Coll.1985;38:13~19
Salo E,Pelkonen P,Pettay O,et al.Outbreak of Kawasaki Syndrome in Finland. Acta P?diatric Scand. 1986 Jan;75(1):75~80
Chang RK. Hospitalizations for Kawasaki disease among children in the United States,1988-1997. Pediatrics.Jun , 2002;109(6):e87
HC Lue,S Philip.Kawasaki Disease in Taiwan: A 4th Nationwide Survey,1994-2000 International Pediatrics Research Foundation Volume 53(1)；2003 January;159~160
王大为，江苏省流行病学调查。中华流行病学杂志，2000；4(21)：94~96
焦富勇，张拓红，陕西省川崎病流行病学调查研究。中华流行病学杂志，2000；4（21）：97~99
Du，Zhong_Dong MD,MPH. Zhang,Tuohong MD,Liang, Lu MD.Meng,xiaoping MD.Li,Tang MD.Kawasaki,Tomisaku MD.Nakamura,Yosikazu MD, MPH, Yanagawa Hiroshi MD. Epidemiologic picture of Kawasaki Disease in Beijing from 1995 through 1999.Pediatric Infections Disease Journal. February, 2002; 21(2): 103~107
Lijie Wu,Huiying Zhang,Yijun Wang et al.Epidemiological Survey of Kawasaki Disease during 1995-2000 in Harbin.International Pediatrics Research Foundation. Volume 53(1)；2003 January;167~168
Xiaoguang Zhou,Shuzhen Wang,et al.Epidemiologic Survey on Kawasaki Disease in South China, 1995-1999 International Pediatrics Research Foundation；Volume 53(1)；January 2003;167~168
Tsuchida,ST. Yamanaka,R.Tsuchida, Y. Nakamura,M Yashiro,and H.Yanagawa.. Epidemiology of infant Kawasaki disease with a report of the youngest neonatal case ever reported in Japan.Acta Pediatr.1996;85:995~997
Freeman,Alexandya F Shulman,Stanford T.Recent development in Kawasaki
Disease .Current opinion in infectous Disease .June 2001;14(3):357~361.
Shulman S,Melish N,Inoue O, et al.Immunoglobulin allotypic markers in Kawasaki Disease.J Pediatr.1993;122(1):497~502.
Anderson NS,Burns J, Treadull TA. Erythrocyte sedimentation rate and C-reactive protein discrepancy and high prevalence of coronary artery abnormalities in Kawasaki disease. Pediatr infect Dis J. .Jul ;2001;20(7):687~702.
Furukara S,Mafsubara T,Umezawa, et al.Serum levels solube tumor necrosis factor receptor during acute Kawasaki Disease [J]. J Pediatr.1994;124;721~725.
Yangawa H,Nakamura YUpdate of epidemiology of Kawasaki disease in Japan. J Epidemiology;1996;6(4):8~15
Hiro j,Hibi S,Andob T,et al.High levels of circulating interleukin-4 and interleukin-10 in Kawasaki disease. Int Arch Allergy immunol.1997;112:152~156.
王宏伟，程佩萱，鲁维伟。川崎病患儿冠状动脉病变发生机理及预防探讨。中华儿科杂志.1998；38：86~88.
Wang CR,Liu MR,Tshi RT,etal. Circulating intercellular adhesion molecules-1 and antibodies includinganti-endothelialcell , anti-cardiolopin and anti-neutrophil cytopasma antibodies in patients with vasculitis [J]. Clin Rheumatol. 1993; 12(3): 376~380.
Yonish-Rouach,Resnitiky D,Lotern J,et al.Wild-type P53 induces apoptosis of myeloid.Leukaemic cells that is inhibited by IL-6 [J].Nature.1991,352:345~347.
刘佳，李宏，Hamou MF,等。IL-6对小兽（杂交瘤） 7TD1细胞凋亡的调控作用[J].中华微生物和免疫学杂志，1995，15（6）：382~385
易岂建，杨锡强，李成荣。IL-6对急性川崎病患者外周血淋巴细胞凋亡影响。中华微生物和免疫学杂志，1998，18（1）：37~40
Furusho K, Kamiya T, Nakano H, Kiyosawa V, et al. High-dose intra venogammaglobulin for Kawasaki disease.Lancet.1984;2:1055~1058
Durongpisitkul K,Gururaj VJ,Park JM,et al.The prevention of coronary artery aneurysm in Kawasaki disease:a mata-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrils.1995;96(6):1057~1061.
Tse SM,Silverman ED,Mccrinadle BW,Yeung RS,Early treatment with intravenous immunoglobulin in patients with Kawasaki disease. J pediatr.2002 Apr; 140(4):
450~455.
Sundel RP.Update on the treatment of Kawasaki disease inchildren. Curr Rheumatol Rep. 2002 Dec;4(6):474~82
Yanagawa H Nakamuray,sakatam et al use of intraeuousr globulin for kawasaki disease effects on cardiac sequelae pediatric cardiol.1997.18 (1):19~23
Newburger JW Kawasaki disease Curr Treament options cardiovasc Med.2000 Jun; 2(3):227~236.
Newburger JW,Takahashi M,Burns JC,Beiser AS,Chung KJ, Duffy E, et al.The treatment of Kawasaki syndrome with intravenous gamme globulin. N Eng1 J Med 1986;315:341~347.
Saulsbury FT.Comparison of high-dose and low-dose aspirin plus intravenous immunoglobulin in the treatment of Kawasaki disease.Clin pediatr (Phila) . 2002 oct ; 41(8):597~601
Moran AM,Newburger JW, Sanders SP, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gamma-globulin.Am Heart. J 2000; 139: 217~223
李永柏, 易岂建, 李秋，等．优选静脉免疫球蛋白剂量治疗川崎病与免疫学效应研究[J]．中华儿科杂志，1999；37(2):97~100
Tsujimoto H,Takeshitu S,Nakatani k,et al.Intravenous immunoglobulin therapy induces neutrophil apoptosis in Kawasaki disease. Clin immunol 2002, 103(2): 161~168.
Yi QJ,Li CR,Yang XQ.Effect of intravenous immunoglobulin on inhibiting peripheral blood lymphocyte apoptosis in acute Kawasaki. Acta pediatr 2001: 90: 623~627.
kato H,Koke S,Yoko yama T Kawasaki disease: Effect of treatment of coronary artery involvement. Pediatr;1979;63(2):175~177.
Shinochara M,Sone K,Tomomasa T,et al.coricosteroids in the acute .kawasaki disease.[J] Pediatr;1999;135:465~469
Cremer H,Rieger C.Epidemiology of Kawasaki disease in Germany (FRG).Prog Clin Biol Res 1987;250:61~65.
Rowley AH,Shulman ST.Kawasaki syndrome [J]. Pediatr Clin North Am, 1999; 46;
313~325
Fulton DR,Newburger JW.Long-term cardiac sequlae of Kawasaki Disease .Curr Rheumatol Rep.2000 Aug;2(4):324~329
Fukunisbi M,Kikawa M,Hamana K, et,al .Pediction of non-responsiveness to intravenous high-dose r-globulin therapy in patients with Kawasaki disease at onset [J]. JPediatr, 2000; 137: 172~176
Sundel.RPJ,C.Burns,A.Baker,A.S.Beiser,and JW Newburger.Gamma globulin re-treatment in Kawasaki disease.J.Pediatr.1993;123:657~659
Wright.DA, JW. Newburger, A Baker, and RP Sundel, Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids. J.Pediatr. 1996; 128:146~149
Newburger JW,Takashi M,Beiser AS,et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Eng J Med1991;324:1633~1639.
Lee MS,An SY,Jang GC,Kim DS.A case of intravenous immunoglobulin-resistant Kawasaki disease treated with methotrexate,Yonsei Med J.2002 Aug; 43(4): 527~532.
Mori M, Imagawa T, Yamaguchi S, et al.Plasma exchange in Kawasaki disease. [J]. Drug. 1999; 58(5):813~822
Kato Hirohisa, Kawasaki disease 1st ed. Amsterdam Elsevier science BV，1995; 187~549