47例6月龄以下婴儿川崎病临床分析

目的：分析6月龄以下婴儿川崎病的临床发病特点。方法：对2005年5月-2008年5月南京儿童医院收治的47例6月龄以下的川崎病患儿进行回顾性分析。结果：6月龄以下婴儿川崎病男女比例为1.35：1,以典型病例多见,约有15%为不完全型病例,主要症状中口唇充血皲裂、手足硬肿和淋巴结肿大的发生比例明显较低,而指趾端脱屑的发生比例较高（P〈0.05）。不完全型组临床表现早期出现少,炎性指标WBC、CRP、ESR明显增高,与典型组比较差异无统计学意义（P〉0.05）。冠脉病变发生比例两组比较差异无统计学意义（P〉0.05）。冠脉扩张共39例（83%）,有11例形成动脉瘤（23%）。不完全型组的平均确诊时间较典型组长（P〈0.05）。结论：婴儿川崎病临床表现无特异性,对发热持续时间长、抗感染治疗无效婴儿应提高警惕,对疑似病例及早行超声心电图检查,了解冠脉情况,检查ESR、CRP,动态观察PLT变化,有助于早期诊断。

Clinical analysis of Kawasaki disease in infants under 6 months: A report of 47 cases

Objective:To analyze the clinical feature of infants aged<6 months suffering from Kawasaki disease(KD).Methods:The data of 47 cases with infant KD admitted from May of 2005 to May of 2008 were analyzed retrospectively.Results:Male-female ratio of infant KD was 1.35:1.The incidence of the typical Kawasaki disease was higher,while the incomplete Kawasaki diseases accounted for about 15%.In the principal clinical features the incidence of erythema and cracking of lips,erythema and edema of the extremities and cervical lymphadenopathy decreased significantly,but the rate of membranous desquamation of fingertips increased(P<0.05).The clinical manifestation of the incomplete group performed lowly in acute stage.The number of white blood cell,C-reactive protein and erythrocyte sedimentation rate was statistically higher,but there was no significant difference in the inflammatory findings between classic and incomplete KD(P>0.05).The rate of coronary artery lesion of incomplete cases appeared to be similar to that of classic cases(P>0.05).Coronary artery abnormalities were seen in 39/47(83%),which occurred in 3-16 days of fever onset.The prevalence of coronary artery aneurysms with KD was 23%.The average final diagnosis time of incomplete Kawasaki disease was longer than that of the typical one(P< 0.05).Conclusion:Attention should be aroused to the infants with fever lasting longer than 5 days if treatment shows no effect.Therefore,they are helpful for early diagnosis such as in time examine of coronary artery abnormalities,ESR and CRP,especially platelet change.