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目的总结不完全川崎病(KD)的临床特征,以期早期诊治,减轻冠脉病变程度,改善预后。方法总结我院2000年10月至2006年3月收治的不完全KD患者47例的临床资料作回顾性分析,并与同期典型病例比较。结果不完全KD发生率婴幼儿较高。不完全KD临床诊断指标中的症状发生率较典型组低,两组差异有统计学意义。不完全KD组肛周充血脱屑发生率38.7%,卡介苗接种处红斑发生率29.0%,为较特征性表现。两组实验室检查指标白细胞、C-反应蛋白、血小板、血沉等差异无统计学意义。不完全KD组二维超声提示冠状动脉受累率51.1%,典型组为33.1%,差异有统计学意义。发病10 d内联合阿司匹林应用大剂量静脉丙球蛋白(IVIG)可取得较好疗效。结论不完全KD多累及小婴儿,较典型KD更易发生冠状动脉受损。诊断中应注意临床诊断指标以外的症状体征,其中肛周充血脱屑和卡斑处红斑可作为川崎病诊断的支持依据,结合实验室检查异常和及时应用超声对冠状动脉病变的检出可做出及时诊断。发病10 d内应用大剂量IVIG可减轻冠脉病变程度,取得较好疗效,改善预后。
Objective To summarize the clinical features of incomplete Kawasaki disease (KD) in order to early diagnosis and treatment, reduce the severity of coronary artery disease and improve the prognosis. Methods The clinical data of 47 patients with incomplete KD admitted to our hospital from October 2000 to March 2006 were retrospectively analyzed and compared with the typical cases of the same period. Incomplete KD incidence of infants and young children is higher. Incomplete KD clinical symptoms in the incidence of symptoms lower than the typical group, the difference between the two groups was statistically significant. Incomplete KD group, the incidence of perianal congestion and desquamation 38.7%, BCG vaccination erythema incidence of 29.0%, for the more characteristic manifestations. There was no significant difference between the two groups in laboratory indexes of white blood cells, C-reactive protein, platelets, erythrocyte sedimentation rate and so on. Incomplete KD group two-dimensional ultrasound showed coronary involvement rate of 51.1%, 33.1% in the typical group, the difference was statistically significant. Intravenous aspirin within 10 days of the application of high-dose intravenous globulin (IVIG) can achieve better results. Conclusion Incomplete KD involving multiple infants, more prone to coronary artery damage than typical KD. Diagnosis should pay attention to clinical signs and symptoms other than indicators, including perianal congestion and scaling and erythema at the card spot can be used as a basis for the diagnosis of Kawasaki disease, combined with laboratory abnormalities and timely detection of coronary lesions can be done A timely diagnosis. The application of large doses of IVIG within 10 days of onset reduced the degree of coronary artery lesion, obtained better curative effect and improved prognosis.