Résumé
PURPOSE: The clinical findings of almost all of the hemophagocytic lymphohistiocytosis (HLH) patients are not significant. Early enforcement of bone marrow study for quicker detection of laboratory abnormalities in routine laboratory test, which is perfomed in febrile patients, is critical for early diagnosis of HLH. In this study, we tried to elucidate more significant laboratory test for the early diagnosis of HLH. METHODS: The study group and control group consisted of 13 HLH patients, and 46 febrile patients with causes like fever of unknown origin, kawasaki disease or acute lymphoblastic leukemia, respectively. Receiver operating characteristic (ROC) curve analysis of various laboratory findings of hyperpyrexic patients on the first day of admission were performed. RESULTS: The total WBC count, platelet count, serum triglyceride, serum transaminase, and serum ferritin revealed statistically significant differences between the study and the control group (P< 0.05). The ROC curve analysis revealed that serum triglyceride was the most efficient test for the differential diagnosis between HLH and febrile patients with other causes. And the serum transaminase, triglyceride and ferritin revealed a statistically significant difference between the study and the leukemia patients group (P< 0.05). The ROC curve analysis revealed that serum transaminase was the most efficient test for differential diagnosis between HLH and acute leukemia. CONCLUSION: In patients with persistent hyperpyrexia, the elevated serum triglyceride level is an important clue for the early diagnosis of HLH. In patient with persistent hyperpyrexia, and abnormal CBC findings, the elevated serum transaminase level is an important clue for the early diagnosis of HLH.
Sujets)
Humains , Moelle osseuse , Diagnostic différentiel , Diagnostic précoce , Ferritines , Fièvre d'origine inconnue , Leucémies , Lymphohistiocytose hémophagocytaire , Maladie de Kawasaki , Numération des plaquettes , Leucémie-lymphome lymphoblastique à précurseurs B et T , Courbe ROC , TriglycérideRésumé
PURPOSE: Kawasaki disease is an acute febrile vasculitis that may cause coronary artery dilatation after the acute phase. We assessed the risk factors of coronary artery dilatation in patients diagnosed with Kawasaki disease. METHODS: From January 1995 through April 2003, a total of 362 patients with Kawasaki disease were enrolled. After dividing these patients into two groups by presence of coronary artery dilatation, we analyzed and compared the early symptoms and laboratory findings. RESULTS: A total of 362 patients were divided into two groups: Group 1 consisted of 65 patients(18.0%) with coronary artery dilatation, while Group 2 consisted of 297 patients(82.0%) with normal coronary arteries. Group 1 exhibited longer duration of fever during the early symptoms and showed elevated levels of CRP and cardiac Troponin-I(cTnI). WBC count, hemoglobin, hematocrit, platelet count, erythrocyte sedimentation rate, hepatic enzymes, serum albumin, CK-MB, total eosinophil count, age and sex were not significantly different between the two groups. CONCLUSION: As the severity of early inflammatory reaction increased, the risk of coronary artery dilatation increased accordingly. Therefore it is essential to establish a treatment to reduce the early inflammatory reaction in order to decrease coronary artery complications.
Sujets)
Humains , Sédimentation du sang , Vaisseaux coronaires , Dilatation , Granulocytes éosinophiles , Fièvre , Hématocrite , Maladie de Kawasaki , Numération des plaquettes , Facteurs de risque , Sérumalbumine , VasculariteRésumé
No abstract available.