川崎病50例误诊分析

Analysis of Misdiagnosis of 50 Cases of Kawasaki Disease

目的研究影响川崎病诊断的因素,了解误诊带来的后果.方法分析50例川崎病误诊病例的临床表现特征,误诊的病症,了解因误诊带来的不良后果.结果调查结果显示,50例误诊的川崎病患儿中,15例误诊为上呼吸道感染,占30%,误诊时间为5 d;10例误诊为肺部感染,占20%,误诊时间8 d;8例误诊为副伤寒,占16%,误诊时间为3 d;7例误诊为过敏性紫癜,占14%,误诊时间为15 d;6例误诊为心肌炎,占12%,误诊时间为11 d;4例误诊为药疹,占8%,误诊时间为9 d.50例误诊的患儿冠脉扩张以及心脏扩大情况与非误诊患儿进行比较,结果显示冠脉扩张误诊病例26例(52%)、瘤样扩张误诊病例12例(24%)、总冠脉扩张误诊病例38例(76%)、心脏扩大误诊病例11例(22%).均明显多于非误诊病例,差异具有统计学意义(P<0.05).结论由于对川崎病认识的不足,病症临床表现不典型,造成川崎病在治疗中容易出现误诊.对此需要提高诊断水平,降低临床误诊率.

Objective To analyze the 50 cases of misdiagnosed Kawasaki disease,study the influencing factors on the Kawasaki disease diagnosis, and understand the consequences of misdiagnosis.Methods The clinical symptoms and features of misdiagnosed cases of Kawasaki disease, and the adverse consequences due to misdiagnosis were analyzed. Results According to the results of the survey, among 50 cases of misdiagnosed Kawasaki disease, 15 cases were misdiagnosed as upper respiratory tract infection, accounting for 30%, the misdiagnosis time was 5 days; 10 cases were misdiagnosed as pulmonary infection, accounting for 20%, the misdiagnosis time was 8 days; 8 cases were misdiagnosed as typhoid fever, accounting for 16%, the misdiagnosis time was 3 days;7 cases were misdiagnosed as Henoch Schonlein purpura,accounted for 14%,the misdiagnosis time was 15 days; 6 cases were misdiagnosed as viral myocarditis,accounted for 12%,the misdiagnosis time was 11days; 4 cases were misdiagnosed as drug eruption, accounted for 8%, the misdiagnosis time was 9 days.The coronary dilatation and heart enlargement was compared between misdiagnosed and non- misdiagnosed patients,the results showed that there were 26 cases of coronary artery dilatation（52%）, 12 cases of aneurysm（24%）, 38 cases of total coronary dilatation（76%）,11 cases of cardiac enlargement（22%） in misdiagnosed patients,which were significantly higher than those of non misdiagnosed cases, the difference was statistically significant（P 〈0.05）. Conclusion Due to the lack of knowledge of Kawasaki disease and the atypical clinical manifestation,misdiagnosis is easy to appear in the treatment of Kawasaki disease.We need to improve the level of diagnosis and reduce the misdiagnosis rate.