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目的回顾性分析43例不典型川崎病临床特点。方法对已经确诊的川崎病患儿的临床表现及实验室检查进行回顾性分析,注意其早期不典型的症状及各种实验室指标的变化。结果发热、指趾端脱皮、结膜充血、口唇皲裂、皮疹、颈部淋巴结肿大、手足硬性水肿的发生率依次为100%、93.7%、67.44%、62.79%、60.46%、48.83%、44.19%。其中白细胞升高、红细胞沉降率增快、CRP增高、血红蛋白下降、血小板升高、冠状动脉改变的发生率分别为79.07%、93.02%、37.21%、100%、32.55%。所有患儿确诊或拟诊后均给予丙种球蛋白、阿司匹林治疗。本组患儿均只具备典型川崎病主要6项诊断标准的2～4项,其中同时具备4项主要表现者28例(65.12%),具备3项主要表现者15例(34.88%)。结论不典型川崎病容易误诊;主要症状太少或不典型时可结合实验室指标给予拟诊,并尽早应用丙种球蛋白和阿司匹林,以减少冠状动脉损害。血小板指数、红细胞沉降率及CRP对早期诊断、治疗和减少不典型川崎病并发症有临床意义。
Objective To retrospectively analyze the clinical features of 43 cases of atypical Kawasaki disease. Methods The clinical manifestations and laboratory tests of children with Kawasaki disease who had been diagnosed were retrospectively analyzed. Attention was paid to the early atypical symptoms and the changes of various laboratory indexes. Results The incidence of fever, toe peeling, conjunctival hyperemia, lip chapped, rash, cervical lymph nodes, and hand and foot edema were 100%, 93.7%, 67.44%, 62.79%, 60.46%, 48.83% and 44.19% . Including leukocytosis, erythrocyte sedimentation rate, CRP increased, hemoglobin decreased, thrombocytopenia, the incidence of coronary artery changes were 79.07%, 93.02%, 37.21%, 100%, 32.55%. All children were diagnosed or after diagnosis were given gamma globulin, aspirin treatment. The children in this group only had 2 ~ 4 of the 6 major diagnostic criteria of Kawasaki disease, including 28 cases (65.12%) with 4 main manifestations and 15 cases (34.88%) with 3 main manifestations. Conclusions Atypical Kawasaki disease is easily misdiagnosed. When the main symptoms are too few or not typical, laboratory tests can be used to diagnose atypical Kawasaki disease, and gamma globulin and aspirin can be used as early as possible to reduce the damage of coronary artery. Platelet index, erythrocyte sedimentation rate and CRP have clinical significance in early diagnosis, treatment and reduction of atypical Kawasaki disease.