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目的:比较不完全川崎病(IKD)和典型川崎病(CKD)的临床特征,提高临床医师对IKD的认识,从而降低误诊率。方法:回顾性分析2004年1月至2013年12月在十堰市中医院住院的105例川崎病患儿临床资料,包括80例CKD和25例IKD,比较分析IKD组和CKD组患儿临床特点、实验室检查、脏器损害情况、诊断时间及住院时间等。结果:两组患儿性别和年龄比较差异无统计学意义(P>0.05),但在<1岁年龄段患儿例数比较差异有统计学意义(χ~2=5.47,P<0.05);与CKD组比较,IKD组口腔黏膜病变、指趾脱皮、皮疹、肛周潮红脱皮及颈部淋巴结肿大的发生率降低(χ~2分别为6.11、16.51、15.80、9.14、9.88,P<0.05或P<0.01);两组白细胞(WBC)计数、红细胞比容(HCT)、最大血小板(PLT_(max))计数、C反应蛋白(CRP)水平、血沉(ESR)、白蛋白(ALB)水平比较差异均无统计学意义(P>0.05);IKD组冠状动脉扩张(CAD)、瓣膜反流、心电图异常发生率高于CKD组(χ~2分别为13.22、4.14、3.96,P<0.05或P<0.01);IKD组诊断时间和住院时间分别为(6.25±3.05)d和(13.85±5.10)d,长于CKD组的(4.50±2.25)d和(11.25±4.50)d(t分别为3.11、2.44,P<0.05或P<0.01),所有KD患儿经静脉滴注丙种球蛋白(IVIG)和口服阿司匹林治疗,均治愈或好转。结论:IKD患儿临床表现不典型,实验室检查与CKD患儿无明显差异,冠状动脉病变(CAL)发生率较CKD高。临床医师应结合实验室检查及心脏影像学检查,及早诊断和治疗。
OBJECTIVE: To compare the clinical features of incomplete Kawasaki disease (IKD) with typical Kawasaki disease (CKD) and to improve clinicians’ awareness of IKD to reduce the misdiagnosis rate. Methods: The clinical data of 105 children with Kawasaki disease hospitalized in Shiyan Hospital of Traditional Chinese Medicine from January 2004 to December 2013 were retrospectively analyzed, including 80 cases of CKD and 25 cases of IKD. The clinical characteristics of children with IKD and CKD were compared , Laboratory tests, organ damage, diagnosis and hospitalization time. Results: There was no significant difference in gender and age between the two groups (P> 0.05). However, there was significant difference in the number of children <1 year old (χ ~ 2 = 5.47, P <0.05). Compared with CKD group, the incidence of oral mucosal lesion, digitate dehiscence, rash, perianal flushing and cervical lymph node enlargement in IKD group decreased (χ ~ 2 = 6.11,16.51,15.80,9.14,9.88, P <0.05 Or P <0.01). The counts of WBC, HCT, PLT max, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and albumin (P> 0.05). The incidences of coronary artery dilatation (CAD), valvular regurgitation and electrocardiogram abnormalities in IKD group were higher than those in CKD group (χ ~ 2 = 13.22, 4.14, 3.96, P <0.01). The diagnostic time and hospital stay in IKD group were (6.25 ± 3.05) days and (13.85 ± 5.10) days respectively, which were longer than those in CKD group (4.50 ± 2.25 days and 11.25 ± 4.50 days, respectively , 2.44, P <0.05 or P <0.01). All KD children were cured or improved by intravenous infusion of IVIG and oral aspirin. Conclusion: The clinical manifestations of IKD children are not typical. There is no significant difference between laboratory and CKD children. The incidence of coronary artery disease (CAL) is higher than CKD. Clinicians should be combined with laboratory and cardiac imaging examination, early diagnosis and treatment.