新疆地区不典型川崎病的临床特征分析与早期诊断

Clinical characteristics and early diagnosis of incomplete Kawasaki disease in Xinjiang

目的探讨不典型川崎病的临床特征,早期诊断的临床依据。方法回顾性分析2002年8月~2009年10月新疆医科大学第一附属医院收治的出院诊断为川崎病的149例患儿的临床资料,比较分析典型和不典型川崎病的临床特点。结果 149例病例中,108例（72.5%）为典型川崎病,41例（27.5%）为不典型川崎病。与典型川崎病相比,不典型川崎病的发热持续时间明显延长。不典型川崎病常见的症状依次为肛周脱皮（61.0%）、口腔黏膜的改变（61.0%）、双侧球结膜充血（56.1%）和皮疹（51.2%）,颈部淋巴结肿大（12.2%）为少见症状。典型川崎病和不典型川崎病实验室检查结果和冠状动脉异常的发生率差异无统计学意义（P〉0.05）。结论当患儿出现持续发热、口腔黏膜改变、双侧球结膜充血、皮疹和肛周脱皮时,应高度怀疑川崎病的可能。

Objective To compare the clinical features and laboratory test characteristics and to explore the early diagnostic methods in children with incomplete Kawasaki disease（IKD）.Methods Retrospective data from 149 cases with a discharge diagnosis of Kawasaki disease（KD） in the first affiliated hospital of Xinjiang medical university were collected from August 2002 to October 2009.We compared the characteristics of cases who satisfied the criteria for complete KD with those of patients who had IKD.Diagnosis of KD was based on 5 clinical features.Some cases who didn＇t fulfill the criteria had been diagnosed as IKD.Results Among the total of 149 cases,108（72.5%） were classical KD and 41（27.5%） were IKD.Compared with classical KD,the duration of fever was longer in IKD.Most common symptoms in the IKD cases were oral mucosal changes（61.0%）,bilateral conjunctival injection（56.1%） and skin rash（51.2%）,yet cervical lymphadenopathy（12.2%） was absent in majority of cases of our series.But crissum scaling（61.0%） was another predominant character in IKD.There was no difference in the laboratory tests and in the risk of coronary artery abnormalities between classical KD and IKD.Conclusion When a child present with prolonged fever,oral mucosal changes,bilateral conjunctival injection,skin rash and crissum scaling,he may highly regarded as KD.Future prospective studies are needed to refine the algorithm further.