川崎病的不典型临床表现

Atypical Manifestations in Children with Kawasaki Disease

目的:了解川崎病(KD)患儿的不典型临床表现及冠状动脉损害情况,探讨其诊断标准。方法:总结75例KD患儿的临床及超声心动图特点。结果:具备主要表现6项者42例(56％),5项23例(30.7％),4项7例(9.33％),3项2例(2.67％),2项1例(1.33％)。某些病例临床表现不典型,如淋巴结肿大为化脓性,皮疹结痂,可有脱指甲表现,病程中可一直无手足末端脱皮。另外发现惊厥、脑膜炎、胆囊炎、脊髓炎等各1例。71例超声心动图检查显示,47例(66.2％)冠状动脉有改变,其中冠状动脉扩张30例(42.3％),冠状动脉瘤17例(23.9％),其中巨大瘤2例。结论:川崎病临床表现多样,某些主要表现可有例外,冠状动脉扩张较常见。

Objective: To explore the atypical manifestations and coronary artery disease in children with Kawasaki disease (KD) and discuss the diagnostic criteria of KD. Methods: The clinical and echocardiographic features of 75 children with KD were analyzed. Results: 42 (56%),23(30.7%),7(9.33%),2(2.67%) and 1(1.33%) cases had 6,5,4,3 and 1 major manifestations, respectively. Some cases showed atypical manifestations, such as suppurative lymphadenopathy, scabbed rashes, drop of the fingernails and no desquamation of the digits during the entire course. Aseptic meningitis, cholecystitis and myelitis were also found. Echocardiographic examinations suggested that 47 cases (66.2%) had coronary artery disease,in which 30 cases (42.3%) suffered from coronary artery dilation, 17 (23.9%) had coronary artery aneurysm (included 2 cases with big aneurysm ). Conclusion: Children with KD varied in clinical manifestations, and there were some exceptions in major manifestations, but coronary artery disease was often found.