不完全型川崎病小儿临床特征分析

Clinical Analysis of Children with Incomplete Kawasaki Disease

目的:研究不完全型川崎病小儿的临床特征,以期早期诊疗,改善预后。方法:分析从2009年1月-2012年4月在武汉大学人民医院儿科收治的不完全型川崎病及典型川崎病患儿的临床资料,比较其在人口学特征、临床表现、实验室检查及治疗效果等方面的差异。结果:58例不完全型川崎病患儿与50例典型川崎病患儿相比,性别与年龄分布无明显差异。不完全型川崎病患儿诊断指标中的症状发生率如结膜充血、多形性皮疹、淋巴结肿大、手足肿胀、脱皮、唇干裂明显低于典型川崎病组患儿(P<0.01)。两组患儿疾病诊断时距起病的时间分别为(7.8±2.0)和(7.3±2.2)d(P=0.188)。实验室检查指标丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、白细胞、血小板、C反应蛋白和血沉等在两组间差异无统计学意义(P>0.05)。冠脉扩张比例在不完全型川崎病组为34.5%,在典型川崎病组为22.0%(P=0.153)。丙种球蛋白治疗效果在两组中无明显差别(P=0.449)。结论:不完全型川崎病患儿主要症状发生率明显低于典型川崎病患儿,在冠脉损害以及丙种球蛋白治疗效果方面与典型川崎病患儿相比并无明显差别。

Objective： To analyze the clinical characteristics of incomplete Kawasaki disease （IKD） for early di- agnosis and treatment of IKD, in order to improve the prognosis of this disease. Methods： The data of children with IKD and KD from January 2010 to April 2012 were retrospectively analyzed. The patients＇ demographics, frequencies of clinical symptoms, laboratory reports, therapeutic responses and coronary artery outcomes were compared between IKD and KD children to explore if there were any differences. Results： Fifty-eight children with IKD and 50 children with KD were analyzed. There was no significant difference in age and gender distribution between two types. The clinical presentations＇ incidences in IKD children such as bilateral conjunctiva injection, cervical lymphadenopathy, polymorphous skin rash, changes in the lips and changes of the distal extremities were significant lower than KD children （P〈 0.01）. The diagnosis durations after the onset of the illness of IKD and KD children were （7.8±2.0） dand （7.3± 2.2） d, respectively （P= 0. 188）. No statistical differences of glutamic-oxalacetic transamin- ease, glutamic-pyruvic transaminase, leukocytesplatelet, C-reactive protein and erythrocyte sedimenta- tion rate were found in them. There no significant difference in the incidence of coronary artery lesions between IKD （34. 5%） and KD （22. 0%） （P〉0.05）. No difference in responses to aspirin and large dose of IVIG （P=0. 449） were found between the two groups. Conclusion. The incidences of clinical presentations such as bilateral conjunctiva injection, cervical lymphadenopathy, polymorphous skin rash, changes in the lips and changes of the distal extremities in IKD were lower than th in KD patients. The coronary artery lesions and treatment responses showed no difference between IKD and KD children.