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目的探讨小儿不完全川崎病(IKD)早期诊断的方法,以提高对该病的临床诊断水平,减少冠状动脉损害的发生。方法对2008年1月-2012年5月在厦门市第三医院儿科住院的21例IKD患儿的临床表现及辅助检查进行回顾性分析。结果持续发热、川崎病面容、手足硬肿、肛周潮红或脱皮、卡巴红等症状及体征有助于IKD的早期诊断。炎症指标(ESR及CRP)、WBC及BNP早期增高以及发病10 d内心脏彩超检查发现冠状动脉扩张是早期诊断IKD可靠的辅助指标。21例IKD患者中发生冠状动脉扩张10例,占47.6%,与典型KD比较,差异有统计学意义(P<0.05)。结论由于IKD病例中冠状动脉病变发生率较高,对持续发热5天以上的婴幼儿,当出现川崎病面容、手足硬肿、肛周潮红或脱皮及卡巴红等表现中的2~3项时要引起重视,尽早做相应的辅助检查及心脏冠状动脉检测,尽早明确诊断,给予早期治疗,以避免冠状动脉损害的发生。
Objective To investigate the method of early diagnosis of incomplete Kawasaki disease (IKD) in children to improve the clinical diagnosis of the disease and reduce the incidence of coronary artery lesions. Methods The clinical manifestations and laboratory examinations of 21 IKD children hospitalized in pediatric department of Xiamen No.3 Hospital from January 2008 to May 2012 were analyzed retrospectively. The results of sustained fever, Kawasaki disease face, hand and foot sclerosis, perianal flushing or peeling, symptoms and signs such as kava red help IKD early diagnosis. The index of inflammation (ESR and CRP), the early increase of WBC and BNP and the examination of echocardiography within 10 days of onset found that coronary artery dilatation was a reliable auxiliary indicator of early diagnosis of IKD. Coronary artery dilatation occurred in 21 cases of IKD patients, accounting for 47.6%. Compared with the typical KD, the difference was statistically significant (P <0.05). Conclusions Because of the high prevalence of coronary artery disease in IKD cases, in infants and young children with persistent fever for more than 5 days, when Kawasaki disease face, cirrhosis, perianal flushing or peeling and karbu red appear in 2-3 items To pay attention, as early as possible to do the appropriate auxiliary examination and cardiac coronary artery detection, as soon as possible a clear diagnosis, given early treatment to avoid the occurrence of coronary artery lesions.