不全性川崎病患儿七例误诊分析

Misdiagnosis Analysis of 7 Children with Incomplete Kawasaki Disease

目的总结不全性川崎病的疾病特点,探讨其误诊原因及预防措施。方法回顾性分析2021年7月至2023年8月收治的7例不完全性川崎病误诊患儿病例资料。结果本组7例中,有3例因反复发热5~12 d就诊,临床表现为持续发热、寒战、纳差;有4例因反复发热、咽部不适、咳嗽7~10 d就诊;3例误诊为脓毒症,4例误诊为肺炎。误诊时间8~19(11.41±2.06)d。7例初诊经过治疗后,病情均未明显好转,于我院就诊,完善心脏超声检查,结合患儿的临床症状及血液实验室检查结果,最终确诊为不全性川崎病。确诊后给予人免疫球蛋白静脉滴注,阿司匹林肠溶片口服(无发热症状后减量),有冠状动脉病变者,根据患儿分级选择药物抗凝治疗,同时给予辅助支持治疗。7例经治疗后,病情好转,随访期间有1例出现反复发热,再次入院,其余6例预后良好。结论不全性川崎病的临床表现不典型,容易与儿科其他感染性疾病混淆而误诊。需加强临床医师对不全性川崎病的认识和鉴别诊断能力,综合分析患儿临床表现及实验室检查结果,完善心脏彩超检查,从而减少误诊的发生。

Objective To summarize the characteristics of incomplete Kawasaki disease and to discuss the causes of misdiagnosis and preventive measures.Methods The case data of seven children with incomplete Kawasaki disease misdiagnosed from July 2021 to August 2023 were retrospectively analyzed.Results Among the 7 patients in this group,3 patients presented with repeated fever for 5-12 d,and the clinical manifestations were persistent fever,chills,and poor appetite.There were 4 patients with recurrent fever,pharyngeal discomfort and cough for 7-10 d.Three patients were misdiagnosed with sepsis and 4 patients with pneumonia.The misdiagnosis lasted 8-19(11.41±2.06)d.After initial treatment,the condition of the 7 patients did not improve significantly.They were treated in our hospital,and after further cardiac ultrasound examination,combined with the clinical symptoms of the children and the results of blood laboratory examination,they were ultimately diagnosed with incomplete Kawasaki disease.After diagnosis,intravenous infusion of human immunoglobulin was given,and aspirin enteric-coated tablets were taken orally(the dosage was reduced after the children had no fever).For patients with coronary artery disease,anticoagulant therapy was selected according to the grade of the children,and auxiliary support therapy was given.The condition of 7 patients improved after treatment.During the follow-up,1 patient had recurrent fever and was rehospitalized,and the remaining 6 patients had a good prognosis.Conclusion The clinical manifestations of incomplete Kawasaki disease are not typical,and it is more likely to be confused with other infectious diseases in pediatrics,resulting in misdiagnosis.It is necessary to strengthen the understanding and differential diagnosis ability of clinicians for incomplete Kawasaki disease,comprehensively analyze the clinical manifestations and laboratory examination results of children,and improve the cardiac ultrasound examination of children,so as to reduce the occurrence of misdiagnosis.