小儿不完全川崎病临床特征分析

Clinical analysis of children with incomplete kawasaki disease

目的总结不完全川崎病(KD)的临床特征,以期早期诊治,减轻冠脉病变程度,改善预后。方法总结我院2000年10月至2006年3月收治的不完全KD患者47例的临床资料作回顾性分析,并与同期典型病例比较。结果不完全KD发生率婴幼儿较高。不完全KD临床诊断指标中的症状发生率较典型组低,两组差异有统计学意义。不完全KD组肛周充血脱屑发生率38.7%,卡介苗接种处红斑发生率29.0%,为较特征性表现。两组实验室检查指标白细胞、C-反应蛋白、血小板、血沉等差异无统计学意义。不完全KD组二维超声提示冠状动脉受累率51.1%,典型组为33.1%,差异有统计学意义。发病10 d内联合阿司匹林应用大剂量静脉丙球蛋白(IVIG)可取得较好疗效。结论不完全KD多累及小婴儿,较典型KD更易发生冠状动脉受损。诊断中应注意临床诊断指标以外的症状体征,其中肛周充血脱屑和卡斑处红斑可作为川崎病诊断的支持依据,结合实验室检查异常和及时应用超声对冠状动脉病变的检出可做出及时诊断。发病10 d内应用大剂量IVIG可减轻冠脉病变程度,取得较好疗效,改善预后。

Objective To analyze the clinical characteristics of incomplete kawasaki disease （KD） for early diagnosis and treatment of incomplete KD, a reduction of the degree of coronary artery lesions and improvement of prognosis. Methods The data of 47 inpatients with incomplete KD from October 2000 to March 2006 were retrospectively analyzed and were compared with typical KD in the same term. Results Incomplete KD was more common in infants. The incidence of symptoms of clinical diagnostic criteria was lower in incomplete KD than that in typical KD. The incidences of reddish anus and desquamation and BCG vaccination red reaction in incomplete KD were 38.7% and 29% respectively,which were distinctive manifestations of KD. No statistical differences of leukocytes, C - reactive protein,platelet and erythrocyte sedimentation rate were found in the incomplete KD and typical KD. There was significant difference in the incidence of coronary artery lesions between incomplete KD （51.1% ） and typical KD （33. 1% ）. Application of Aspirin and large dose of IVIG within 10 days after onset of KD could make better therapeutic effect. Conclusion The proportion of incomplete KD is high in younger infant, and the incidence of coronary artery lesions is higher in incomplete KD than that in typical KD. The symptoms and physical signs not included in clinical diagnostic criteria, especially reddish anus and desquamation and BCG vaccination red reaction, should be paid attention in the diagnosis and synthetically analysed with echocardiography and abnormality in laboratory examination ,which can be helpful to the timely diagnosis of KD. Application of large dose of IVIG within 10 days after onset of KD can reduce the degree of coronary artery lesions and make better therapeutic effect and improve prognosis.