小儿不典型性川崎病早期诊断的临床探讨

目的探讨小儿不典型性川崎病早期诊断策略,旨在深化对不典型性川崎病的认识,提高临床对小儿不典型性川崎病的早期诊断率。方法回顾对比分析2009年1月至2013年1月经本院诊治的典型性和不典型性56例川崎病患儿的临床早期诊断资料;其中典型组35例,不典型组21例;典型组依据川崎病诊断标准诊断,符合规定中的5项,不典型组患儿符合规定中的2～4项,做实验室相关指标检测和心脏彩超或超生心电图检查辅助诊断;采用SPSS17.0处理数据。结果两组患儿均有持续高烧症状;与典型组比较,不典型组患儿的临床症状较少,一般不足4项诊断标准要求;不典型组内各个症状组比较,高热、红疹、唇裂杨梅舌发病率显著高于其他组（P〈0.05）;不典型组患儿实验室检测值和心电或心脏彩超检查结果均有不同程度的异常改变。结论小儿不典型性川崎病特征性临床表现较少,且多样不一,易与其他病症混淆或被忽视,造成误诊漏诊;对有持续发烧,川崎病典型性临床表现不显著的患儿,应结合实验室检测指标及心脏彩超或超生心电图结果尽早确诊并行免疫球蛋白治疗,防止患儿冠状动脉病变的发生及加重。

Children are not typical of clinical early diagnosis of Kawasaki disease.

Objective To investigate the children with atypical Kawasaki disease diagnosis strategy, is to deepen the understanding of atypical Kawasaki disease in children, improve the clinical early diagnosis of atypical Kawasaki disease rate of. Methods Retrospectively analyzed clinical early in 2009 January to 2013 1 menstrual the hospital for treatment of typical and atypical Kawasaki disease in 56 cases of diagnostic data; the typical group of 35 cases, 21 cases of atypical group; typical groups according to diagnosis standard of Kawasaki disease, with 5 in the provision, atypical groups comply with 2-4 regulations of related index, laboratory testing and cardiac ultrasound or ultrasound cardiogram diagnosis; SPSS 17.0 is used to process the data. Results Two patients had sustained high fever symptoms; compared with the typical group, not less typical clinical symptom groups, generally less than 4 criteria; atypical group in each symptom group, high fever, rash, cleft lip Yang Mei tongue incidence rate was significantly higher than other groups （P 0.05）; not typical group in laboratory detection and ECG and echocardiography examination results have different degree changes. Conclusion Children with atypical Kawasaki disease characteristic clinical manifestation is less, and not a diverse, easily confused with other diseases or ignored, resulting in misdiagnosis and missed diagnosis of persistent; have a fever, the typical clinical features of Kawasaki disease was not significant in children, should be combined with laboratory test index and cardiac ultrasound or ultrasound ECG results diagnosed early parallel immune globulin treatment, prevent occurrence and exacerbation in children with coronary artery lesions.