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目的总结不完全川崎病(incomplete KD)的临床特征,以便早期诊治,减轻冠状动脉的病变程度,改善预后。方法回顾性分析2006年1月—2008年12月期间70例住院不完全KD患儿的临床资料:(1)总结不完全性KD的临床特征;(2)分析不完全KD出现冠状动脉病变(coronary artery lesion,CAL)的高危因素(3)总结静脉注射免疫球蛋白对不完全KD的疗效;(4)随访观察其中的患儿,比较IVIG400mg/kg、1g/kg和2g/kg治疗的远期疗效。结果 (1)70例不完全KD中结膜充血出现最早,其他临床症状发生出现较晚;(2)不完全KD发生冠状动脉病变,以冠状动脉扩张的发生率最高;(3)不完全KD发生冠状动脉病变与年龄、性别、血小板、CRP、ESR和接受IVIG的时间有密切关系(P<0.05)。(4)IVIG400mg/kg较1g/kg和2g/kg治疗组的CAL发生率明显增高,具有统计学意义(P>0.05);1g/kg和2g/kg治疗组的CAL发生率差异不大,无统计学意义。结论 (1)不完全KD的临床表现不典型,指趾端脱皮可以作为不完全性KD的诊断依据之一,而超声心动图对不完全KD的早期诊断更为重要;(2)年龄、性别、血小板、CRP、ESR和接受IVIG的时间是不完全KD发生冠状动脉病变的高危因素,不完全KD发生冠状动脉病变以冠状动脉扩张最为常见;(3)IVIG1g/kg和2g/kg治疗不完全KD的疗效相似,较400mg/kg治疗KD的疗效佳。
Objective To summarize the clinical features of incomplete KD in order to make early diagnosis and treatment, reduce the severity of coronary artery disease and improve the prognosis. Methods The clinical data of 70 hospitalized children with incomplete KD from January 2006 to December 2008 were analyzed retrospectively: (1) to summarize the clinical features of incomplete KD; (2) to analyze the coronary artery lesions in incomplete KD coronary artery lesion, CAL); (3) Summarize the curative effect of intravenous immunoglobulin on incomplete KD; (4) follow-up observation of children with IVIG400mg / kg, 1g / kg and 2g / kg Period of efficacy. Results (1) 70 cases of incomplete conjunctival hyperemia in KD first appeared, other clinical symptoms occurred later; (2) incomplete KD coronary artery disease, the highest incidence of coronary artery dilatation; (3) incomplete KD occurred Coronary artery disease was closely related to age, sex, platelet count, CRP, ESR and time to IVIG (P <0.05). (4) The incidence of CAL in IVIG400mg / kg group was significantly higher than that in 1g / kg and 2g / kg treatment group (P> 0.05). There was no significant difference in the incidence of CAL between 1g / kg and 2g / No statistical significance. Conclusions (1) The clinical manifestations of incomplete KD are not typical. Finger-tip debridement may be one of the diagnostic criteria for incomplete KD. Echocardiography is more important for early diagnosis of incomplete KD. (2) Age and gender , Platelets, CRP, ESR and IVIG were the risk factors for coronary artery disease in incomplete KD. Coronary artery dilatation was the most common in KD. (3) Incomplete treatment with IVIG 1g / kg and 2g / kg KD similar efficacy, more effective than 400mg / kg treatment of KD.