1991至2001年与2002至2011年川崎病临床特点的异同

Clinical similarities and differences in Kawasaki disease during 1991 -2001 and 2002 -2011 periods

目的总结近20年来川崎病（KD）的临床特点及其变化规律，以提高不典型KD的诊治水平。方法回顾性分析广州医学院第二医院20年来（1991年12月至2011年12月）收治的KD患儿的临床资料270例，以2001年12月为分界点，比较前后10年其临床表现的变化特征。2001年12月后的病例为观察组（192例），2001年12月前的病例为对照组（78例）。并比较2组的流行病学特征、临床表现、脏器损害、实验室检查指标。各项数据应用SPSS13．0软件行统计学分析。结果1．观察组〈1岁患儿比例、不完全KD的发生率明显高于对照组（P均〈0．01）；2．观察组皮疹、口腔黏膜改变、结膜充血、手足硬肿、颈淋巴结大的发生率显著低于对照组（P均〈0．01）；3．观察组冠状动脉损害的发生率显著高于对照组（P〈0．05）；4．2组间炎症指标差异无统计学意义（P均〉0．05）。结论近10年来1岁内婴儿的KD发病率增加，不完全KD病例增多，尤以小婴儿多见，冠状动脉损害发生率增高。对不完全KD，应结合实验室柑关炎症指标作出早期诊断。

Objective To analyze the changes in clinical characteristics of Kawasaki disease （KD） between the first and the second decade and improve the diagnosis and treatment of incomplete KD. Methods Retrospective a- nalysis of clinical data of children with KD was performed in the Second Affiliated Hospital of Guangzhou Medical Co- liege during the recent 20 years （between Dec. 1991 and Dee. 2011 ）. The changes in clinical manifestations of KD were compared between the first 10 years and the second 10 years. A total of 270 hospitalized patients diagnosed as KD were included in this study. The patients admitted after Dec. 2001 were assigned as the observation group （192 cases） and those admitted before Dec. 2001 were assigned as the control group （78 cases）. The epidemiologic characteristics, clini- cal manifestations, impairment of organs, and laboratory findings were compared between the 2 groups and statistic anal- ysis was performed on the available date. Results 1. The rate of KD patients 〈 1-year-old and the incidence of incom- plete KD in the observation group were significantly higher than those in the control group （ all P 〈 0.01 ） ; 2. The inci- dences of rash, changes in oral mucosa, congestion of conjunctiva, hardening edema of hands and feet, lymph node en- largement in the observation group were significantly lower than those in the control group （ all P 〈 0.01 ） ; 3. Inci- dence of coronary artery impairment in the observation group was significantly higher than that in the control group （ P 〈 0.05 ） ; 4. There were no significant differences for inflammation index between the 2 groups （ all P 〉 0.05 ）. Con- clusions The incidence of KD and the number of cases with incomplete KD increased in the last decade, especially in younger infants ,and the incidence of coronary arteries impairment is increased. To incomplete KD, combining clinical manifestations with laboratory findings of inflammation index are needed for early diagnosis.