凉山彝族地区不完全川崎病临床调查分析

摘要

Objective To investigate the incidence, age structure, clinical features, complications and treatment conditions of incomplete Kawasaki disease in Liangshan Yi area in the past 9 years.Methods In this study, retrospective analysis and follow-up study were conducted on 83 confirmed cases of incomplete Kawasaki disease from hospitals in 17 counties of the prefecture, and the comparison was made with the complete Kawasaki disease.Results There were 83 confirmed cases of incomplete Kawasaki disease out of 307 cases of Kawasaki disease, with the proportion of incomplete Kawasaki disease.There were no significant differences in gender and age between incomplete Kawasaki disease and complete Kawasaki disease (P＞0.05).The most common clinical manifestation was fever, followed by the changes of oral mucosa, and lymphadenectasis was very rare.There were significant differences in the symptoms, except fever, between incomplete Kawasaki disease and complete Kawasaki disease (P＜0.05 ).Coronary artery lesions occurred in 37 cases,accounting for 44.58 percent of incomplete Kawasaki disease cases, indicating no significant difference from those of complete Kawasaki disease ( P＞0.05 ).However, there was significant difference in incidence of moderate to severe coronary artery lesions between the complete and incomplete Kawasaki disease groups ( P＜0.01 ).In the second week of the course of incomplete Kawasaki disease, platelets count significantly increased, while the white blood cells count decreased considerably, which were consistent with the symptoms of complete Kawasaki disease.Serum CRP concentration in incomplete Kawasaki disease group was 37.86±48.89mg/L, which was significantly lower than that in the complete Kawasaki disease group (P＜0.05).R-Globulin sensitivity of incomplete Kawasaki disease was high, which was significantly different from that of complete Kawasaki disease(P＜0.01).Conclusion The incidence rate of incomplete Kawasaki disease in Liangshan Yi area was higher than that in other large sample surveys in China.Age was not the main cause of incomplete Kawasaki disease.The differences in clinical features are not diagnostic indicators of incomplete Kawasaki disease.Cardiovascular damages, especially moderate to severe coronary artery lesions, continue to be the most common and serious complications of incomplete Kawasaki disease.%目的 了解四川省凉山彝族地区近9年来不完全川崎病的发病情况、年龄构成、临床特点及并发症和治疗情况,提高对不完全川崎病的认识和诊疗水平.方法 对全州17个县市各医院确诊的不完全川崎病83例进行回顾性分析和随访调查,并与完全川崎病进行比较.结果 307例川崎病中83例为不完全川崎病,发生率为27%.不完全川崎病在性别、年龄构成与完全川崎病均无显著性差异(P＞0.05).不完全川崎病最常见的临床表现为发热,其次是口腔粘膜的改变,最少见的为淋巴结肿大.除发热外,其余各项表现与完全川崎病比较差异均有显著性(P＜0.05);冠状动脉损害37例(44.58%),与完全川崎病的冠脉损害差异无显著性(P＞0.05),但中度以上冠脉损害则与完全川崎病组有显著差异(P＜0.01).不完全川崎病程第二周血小板明显增高,白细胞明显下降,与完全川崎痛完全一致.不完全川崎病血清CRP为(37.86士48.89)mg/L,明显低于完全川崎病组,两组间差异有显著性(P＜0.05).不完全川崎病对丙球敏感,与完全川崎病差异有显著性(P＜0.01).结论 ①凉山州不完全川崎病发生率高于国内大样本调查的发生率.②年龄大小不是引起不完全川崎病的主要原因.③临床表现的差异不是诊断不完全川崎病的指标.④心血管的损害,特别是冠状动脉的中重度损害仍然是不完全川崎病的最常见和最严重的并发症.⑤不完全川崎病对丙球治疗反应敏感,早期使用,可有效防止冠状动脉病变的发生率.