以颈部淋巴结肿大和发热为首发症状的川崎病特征研究

Kawasaki disease with lymphadenopathy and fever as initial manifestations

目的:总结一种以颈部淋巴结肿大和发热为首发症状的川崎病的临床特点,旨在提高临床医师对该类型川崎病的认识。方法:对华中科技大学同济医学院附属协和医院2005年1月—2010年5月收治的82例川崎病患儿中的13例以颈部淋巴结肿大和发热为首发症状的川崎病患儿进行了回顾性分析。结果:该调查中共有13例以颈部淋巴结肿大和发热为首发症状的川崎病患儿,其中男9例,女4例。男女比例2.25∶1;其平均年龄5.5岁。起病至确定诊断的平均时间为8.4d。13例患儿在疾病早期全部被误诊为急性淋巴结炎而采用抗感染治疗。其中有9例(69.2%)出现冠状动脉损害。结论:以颈部淋巴结肿大和发热为首发症状的川崎病多见于年龄较大的患儿,往往表现出较强的炎症反应。而且由于其他主要临床表现在病程中出现的时间分散,容易造成川崎病诊断的延误,且其冠状动脉损害的发生率也较高。故临床上对于发热伴颈部淋巴结肿大的年长患儿,应警惕川崎病的发生,使其得到早期及时的治疗。

Objective：To describe a group of patients with kawasaki disease who had lymphadenopathy and fever as their initial manifestations.Method：We retrospectively reviewed 13 children who were admitted to wuhan Union Hospital from January,2005 to May,2010 with the initial impression of cervical lymphadenopathy and fever and which a diagnosis of kawasaki disease was established later.Result：A total of 13 patients were included in this study;9 patients male and 4 were female ;the male and female ratio is 2.25.The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 8.4 days.All of the 13 patients were misdiagnosed as acute cervical lymphadenitis and empiric antibiotics were prescribed in each case with unsatisfactory response.9 of the 13 patients（69.2%）developed coronary artery lesions.Conclusion：Patients with fever and lymphadenopathy as their initial presentations are older.The onset of other signs except fever and lymphadenopathy are dispersed in the course of the illness.These patients are notable for a high incidence of coronary artery involvement because of a delay in diagnosis and strong inflammation.So when children,especially older children have fever and cervical lymphadenopathy and are unresponsive to empirical antibiotics,Kawasaki disease shoule be considered so that they can be treated accurately at the early stage of illness.