不完全川崎病的早期诊断和临床特征

目的 探讨不完全川崎病(IKD)的早期诊断和临床特征,以提高川崎病(KD)的早期诊断率,减少KD延迟诊断及冠状动脉病变(CAL)的发生.方法 对2000年1月-2010年1月收治的42例IKD患儿和147例典型KD进行回顾性分析.分别对IKD和典型KD患儿的年龄、性别、临床特点包括发热、淋巴结大、指(趾)端脱皮、球结膜充血、手足硬性水肿、皮疹、口腔黏膜充血、肛周脱屑、卡介苗接种处再现红斑(卡疤红肿)]、实验室特点包括血WBC计数、Hb、PLT计数、ESR、CRP、血清清蛋白(Alb)、血清ALT、血钠]、心脏彩超及心电图等临床资料进行比较.应用SPSS 17.0软件对数据进行统计学处理.结果 IKD组与典型KD组比较发病无性别差异,但发病年龄小;IKD组诊断时发热持续时间长;IKD组急性期手足硬肿、口腔黏膜充血、球结膜充血、皮疹方面低于典型KD组,而卡疤红肿则多于典型KD组;IKD组 WBC计数及CRP较典型KD组高;2组心电图异常比较差异无统计学意义,但IKD组发生CAL高于典型KD组.结论 IKD患儿CAL发生率高,小年龄、发热时间长、卡疤红肿、WBC计数及CRP明显升高有助于IKD诊断.尽早完善相关实验室检查可减少IKD延迟诊断及CAL发生.

Early Diagnosis and Clinical Features of Incomplete Kawasaki Disease in Children

Objective To explore the early diagnosis and clinical features of incomplete Kawasaki disease(IKD) in children,in order to promote early diagnosis,reduce or avoid coronary artery lesions(CAL) caused by delayed diagnosis of Kawasaki disease(KD).Methods The clinical features of 42 children with IKD and 147 children with KD collected from Jan.2000 to Jan.2010 were retrospectively analyzed.The data between 2 groups in age,gender,clinic features such as fever,lymphadenectasis,finger or toe tip desquamation,conjunctival hyperemia,hardness hydropsia,rash,oral mucosa congestion,crissum desquamation,erythema in Bacillus Calmette-Guerin(BCG) inoculation place],laboratory examinations including white blood cell,hemoglobin,platelet,erythrocyte sedimentation rate,C reactive protein(CRP),albumin,alanine aminotransferase and serum sodium],heart color Doppler examine and electrocardiogram were analyzed by SPSS 17.0 software.Results There was no difference in gender between IKD group and KD group,but IKD group had younger age of onset and longer persistence time of fever.IKD group had lower incidence of extremity hardness hydropsia,oral mucosa congestion,conjunctival hyperemia and rash in the acute stage.Erythema in BCG inoculation appeared often in KD group.IKD group had higher white blood count and CRP.There was not statistical difference in abnormal electrocardiogram between 2 groups,but IKD group had higher CAL incidence rate.Conclusions IKD children have higher incidence of CAL.Lower onset age,longer persistence of fever,erythema in BCG inoculation place,and obvious WBC and CRP rise are helpful for diagnosis of IKD.As early as possible complete laboratory examination is very important to reduce delayed diagnosis and avoid CAL.