小儿不完全川崎病的早期诊断和相关因素分析

目的探讨小儿不完全川崎病（KD）的早期诊断，综合分析其临床特征和实验室检查特点。方法对36例诊断为不完全KD患儿的临床资料进行回顾性分析，总结不完全KD年龄、性别特点、临床表现及实验室检查指标。结果（1）不完全KD多发于年龄小于1岁的婴儿（47．5％），男女比例大致相当（1．25：1）。临床表现除发热外，以双侧结膜充血（77．8％）和口唇干红、皲裂（6；3．9％）多见，其他依次为颈淋巴结肿大（56．1％）、杨梅舌，口腔黏膜及咽部弥漫性充血（16．6％），手足硬肿、掌红斑出现率相对较低（13．9％）。多形性皮疹也不多见，有时呈一过性皮疹（8．5％），急性期无指趾端膜样脱皮和肛周脱皮，无早期诊断价值。（2）不完全川崎病急性期可见白细胞总数升高（15．5～51．6×109／L），以成熟和未成熟粒细胞为主；轻中度贫血（血红蛋白84～135g／L，平均105g／L）；血沉（EsR）55～128mm／h，平均数为76mm／h，c反应蛋白（cRP）12～157mg／L，平均数87mg／L，均显著升高；病程7～14-d．血小板（PLT）增多（215．4～675．7×109／L，平均数为4-58．7×109／L）。结论不完全KD在婴儿（≤1岁）中发生率较高，其临床表现不典型，往往不能得到及时诊断和治疗。在临床表现条件不足时，白细胞总数、血沉、血红蛋白、C反应蛋白、血小板数变化是早期诊断不完全川崎病重要的实验室检查指标。

Object To investigate the effect of children with incomplete Kawasaki disease （KD） in the early diagnosis and comprehensive analysis the clinical features and laboratory features. Methods The clinical data of 36 cases diagnosed as incomplete KD were analyzed retrospectively and checked the summary indicators such as age, gender characteristics, clinical manifestations and laboratory indexes. Results （1） Incomplete KD was multiple in less than 1 years of age infants （47.3%）, the proportion of men and women was roughly equal （1.25：1）.The clinical manifestations concluded fever, bilateral conjunctival congestion （77.8%）, dry and chapped lips （63.9%）, followed by cervical lymph node enlargement （36.1%）, myrica tongue, oral mucosa and pharyngeal diffuse hyperemia （16.6%） and swelling, palmar erythema was relatively low （13.9%）. Pleomorphic rash also does not see more, sometimes showed a transient rash （8.3%）, no tuft membrane peeling and perianal skin peeling in acute period, so lacked the early diagnostic value. （2） The number of WBC （13.5-31.6×109/L） was elevated obviously in acute stage of incomplete Kawasaki disease, mainly in mature and immature granulocyte; mild to moderate anemia （hemoglobin of 84-135 g/L, 105 g/L on average）; erythrocyte sedimentation rate （ESR） of 35-128 mm/h（average 76mm/h）and C reactive protein （CRP） 12-157 mg/L（average 87 mg/L）inereased significantly; platelet （PLT） was increased （215.4-675.7×109/L, average 458.7 ＊ 109/L） during the course of 7-14 d of disease. Conclusion Incomplete KD has higher incidence rate in infants （≤ lyear）, the clinical manifestation is not typical, often can not get timely diagnosis and treatment. In terms of clinical manifestation is insufficient, changes in total white blood cell count, erythrocyte sedimentation rate, hemoglobin, C reactive protein, platelet count are important laboratory indexes to early diagnosis the incomolete Kawasaki disease.