Journal of Clinical Pediatrics ›› 2023, Vol. 41 ›› Issue (7): 486-491.doi: 10.12372/jcp.2022.23e0317
• Original article • Previous Articles Next Articles
HAO Sheng, HUANG Min
Received:2023-04-13
Published:2023-07-15
Online:2023-07-05
HAO Sheng, HUANG Min. Clinical diagnosis and treatment of Kawasaki disease-associated macrophage activation syndrome in children[J].Journal of Clinical Pediatrics, 2023, 41(7): 486-491.
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| HLH-20041) | HLH-20091) | 2016SJIA-MAS共识标准2) | 2020KD-MAS共识标准2) |
|---|---|---|---|
| 以下8条至少符合5条: (1)发热:体温>38.5℃,持续>7 d (2)脾大 (3)血细胞减少(两系或三系) Hb<90 g·L-1(4周以内婴儿Hb<100 g·L-1) PLT<100×109·L-1 中性粒细胞<1.0×10·L-1,且非骨髓造血功能减低所致 (4)高三酰甘油血症(空腹三酰甘油>3.0 mmol·L-1或265 mg·dL-1)和/或低纤维蛋白原血症( <1.5g·L-1) (5)骨髓、肝脏、脾脏、淋巴结发现噬血细胞 (6)NK细胞活性降低或完全缺乏 (7)血清铁蛋白>500 μg·L-1 (8)可溶性CD25(可溶性IL-2受体)≥2 400 U·mL-1 | (1)以下4条至少符合3条: ①发热 ②脾大 ③血细胞减少(外周血三系中至少两系以上减少) ④肝炎表现 (2)以下4条至少符合1条: ①骨髓、脾脏或淋巴结中发现噬血现象 ②铁蛋白升高 ③可溶性L-2受体(SCD25)水平升高(有年龄相关性) ④NK细胞活性减低或缺失 (3)其他支持HLH诊断的指标: ①高三酰甘油血症 ②低纤维蛋白原血症 ③低钠血症 | (1)铁蛋白>684 mg·mL-1 (2)血小板≤181×109·L-1 (3)天门冬氨酸氨基转移酶>48 U·L-1 (4)三酰甘油>1 560 mg·L-1 (1.76 mmol·L-1) (5)纤维蛋白原≤3 600 mg·L-1 诊断条件:(1)为必备条件,(2)~(5)满足任意2条或2条以上(需排除伴发免疫介导的血小板减少症,传染性肝炎、内脏利什曼病和家族性高脂血症等疾病) | (1)铁蛋白进行性升高 (2)血小板急剧下降 (3)天门冬氨酸氨基转移酶高于基线数倍 (4)三酰甘油急剧升高 (5)纤维蛋白原明显降低 (6)骨髓或其他组织(淋巴结、肝脏、脾脏等)发现噬血细胞 诊断条件:(1)为必备条件 (罕见病例除外),(2)~(6)满足任意2条或2条以上 |
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