单中心9年不完全川崎病回顾性分析

摘要

目的 探讨不完全川崎病(KD)的临床特征,以提高临床诊治水平.方法 回顾性分析2002年1月至2010年12月KD住院患儿的临床资料,比较不完全KD与典型KD在发病年龄、性别、临床表现、实验室检查、治疗及冠状动脉损害等方面的差异.结果 1 484例KD患儿进入分析,其中不完全KD 262例(17.6%),典型KD 1 222例;<1岁患儿中不完全KD占24.9%.不完全KD和典型KD患儿的平均发热时间分别为(7.8±5.0)和(6.7±3.6)d,差异有统计学意义.不完全KD四肢改变、多形皮疹、眼结膜充血、口唇改变、颈部淋巴结肿大和肛周改变的发生率显著高于典型KD;卡疤改变、扁桃体肿大、阴囊或外阴改变、呕吐和腹泻的发生率与典型KD差异无统计学意义.两组CRP、ESR、Hb、WBC、PLT、ALT、AST、CK-MB和LDH等实验室指标差异无统计学意义.不完全KD与典型KD患儿对IVIG无反应的发生率差异无统计学意义(14.1% vs 17.5%);不完全KD患儿冠状动脉扩张、冠状动脉瘤和巨大冠状动脉瘤的发生率分别为57.5%、14.1%和1.9%,典型KD患儿分别为31.5%、5.9% 和0.6%,两组差异有统计学意义.结论 不完全KD较典型KD发热时间长,且冠状动脉损害发生率高,但实验室指标差别不大.%Objective To summarize the clinical feature, diagnosis, treatment and prognosis of incomplete Kawasaki disease ( KD ) cases from Beijing Children's Hospital and improve the levels of diagnosis and treatment. Methods A retrospective review of patients with KD from January 2002 to December 2010 in Beijing Children's Hospital was performed. Demographic and clinical data included gender, age, recurrence rate, clinical manifestation ( including fever, bilateral conjunctival injection, changes in the lips and oral cavity, nonpurulent cervical lymph ad eno pat hy, polymorphous exanthema, changes in the extremities, recurrent redness and erythema around the BCG scar, changes around anus, vomiting, diarrhea, swelling of tonsil and changes of external genitalia), treatment and coronary artery lesion. Laboratory examinations included C-reacting protein, erythrocyte sedimentation rate, hemoglobin, white blood cell, percentage of white blood cells representing neutrophils ( % neutrophils ), platelet count, sodium, albumin, aspartate ami notransferase, alanine aminotransferase, γ-glutamyl transferase, total bilirubin, CK-MB and lactate dehydrogenase ( LDH ). Results A total of 1 484 patients with KD were analyzed. The incidence rate of incomplete KD was 17. 6%( 262 cases ); furthermore, the rate in patients younger than 1 year old was 24. 9%. The recurrent rate of KD in incomplete KD cases was 1. 5% , similar to that in complete KD cases ( 1. 8% ). Duration of febrile of incomplete KD was (7.75 ±5.01 ) days, longer than that of complete KD [ ( 6. 68 ± 3. 63 ) days ]. There were no significant differences between incomplete and complete KD in clinical manifestations such as recurrent redness and erythema around the BCG scar, swelling of tonsil, changes of external genitalia, vomiting and diarrhea. The incidence rate of changes around anus was higher in complete KD than in incomplete KD. The differences in laboratory variables were not significant except for albumin, which was lower in complete KD. Days of illness at initial treatment of incomplete KD was ( 8. 57 ± 5. 25 ) days, longer than that of complete KD [ ( 6. 94 ± 3. 55 ) days ]. The incidence rate of IVTG-resistant KD was not significantly different. The incidence rates of coronary artery dilatation, coronary artery aneurysm and giant coronary artery aneurysm was higher than that in incomplete KD than complete KD (57.5% vs3l.5%; 14.1% vs5.9%; 1.9% vs().6% ). Conclusions The duration of febrile and incidence of coronary lesion in incomplete KD were siginificantly longer and higher than those in complete KD, however the incidence of abnormal laboratory examination was not significantly different between incomplete KD and complete KD.