不完全型川崎病患儿的临床特点分析

Clinical Characteristics of Children with Incomplete Kawasaki Disease

目的比较分析不完全型川崎病(incomplete Kawasaki disease,IKD)和完全型川崎病(complete Kawasaki disease,CKD)患儿的临床特点,为IKD患儿的早期临床诊治提供可靠依据。方法采用回顾性研究方法,分析徐州市中心医院2020年12月~2022年8月收治住院的97例川崎病患儿的临床资料,包括67例CKD和30例IKD,观察比较两组患儿的性别、年龄、临床特征、实验室各项指标、影像学检查结果及治疗效果等。结果两组患儿的性别、年龄比较,差异无统计学意义(P>0.05),两组患儿均有发热,但IKD组患儿发热时间长于CKD组患儿的发热时间,差异有统计学意义(10.53±2.29天vs 7.52±2.16天,t=6.227,P<0.05)。与CKD组比较,IKD组患儿口腔黏膜改变、眼结膜充血、肛周脱皮、颈部淋巴结肿大、四肢末梢改变的发生率均降低,差异有统计学意义(P均<0.05)。两组患儿白细胞计数、血细胞比容、最大血小板计数、C反应蛋白、红细胞沉降率、血红蛋白、白蛋白、丙氨酸氨基转移酶、血钠浓度、尿沉渣中白细胞计数各项实验室指标比较,差异均无统计学意义(P均>0.05)。IKD组患儿冠状动脉扩张发生率以及静脉注射丙种球蛋白(intravenous immunoglobulin,IVIG)耐药的发生率均明显高于CKD组患儿,两组比较差异有统计学意义(P<0.05)。所有KD患儿经IVIG和口服阿司匹林治疗,均治愈或好转。结论IKD患儿相对于CKD患儿发热时间长,临床表现不典型,实验室检查与CKD患儿差异无统计学意义,冠状动脉病变发生率及对IVIG的耐药率均较CKD高。临床医师应通过仔细观察患儿的临床表现,结合实验室检查及心脏影像学检查,尽早确诊,并积极给予IVIG应用,尽快减轻炎性反应,改善患儿预后。

Objective To analyze and compare the clinical characteristics of incomplete Kawasaki disease(IKD) and complete Kawasaki disease(CKD) and provide evidence for early clinical diagnosis of IKD children.Methods The clinical data of 97 children with Kawasaki disease in Xuzhou Central Hospital from December 2020 to August 2022 were analyzed retrospectively,67 cases were CKD and 30 cases were IKD.The clinical data including clinical manifestations,laboratory examination results,imaging diagnosis,and treatment effects of children were analyzed.Results There was no significant difference between the sex and age of the two groups(P<0.05).Both groups had fever,but the fever time in the IKD group was longer than the fever time in the CKD group,and the difference was statistically significant(10.53±2.29days vs 7.52±2.16days,t=6.227,P<0.05).Compared with the CKD group,the incidence of oral mucosal changes,ocular conjunctival congestion,perianal peeling,neck lymphadenopathy,and limb peripheral changes in the IKD group were reduced statistically(P<0.05).There was no significant difference in white blood cell(WBC) count,hematocrit(HCT),maximum platelet(PLTmax) count,C-reactive protein(CRP) level,erythrocyte sedimentation(ESR),hemoglobin(Hb) count,albumin(ALB) level,alanine aminotransferase(ALT),serum sodium concentration,and leukocyte count in urine sediment(P>0.05).The incidence of coronary artery dilation and intravenous gamma globulin resistance in the IKD group were significantly higher than that in the CKD group(P<0.05).All children with KD were cured or improved with intravenous immunoglobulin(IVIG) and oral aspirin.Conclusion Children with IKD have a longer fever time compared with children with CKD.The clinical manifestations are atypical,and there is no significant difference between IKD and CKD in laboratory examinations.The incidence of coronary artery disease among IKD is higher than that of CKD.Clinicians should carefully observe the clinical manifestations,combining laboratory tests and cardiac imaging to confirm the diagnosis,and use IVIG to reduce the inflammatory response and improve the prognosis.