1岁以下小儿不典型川崎病的诊断与治疗

目的探讨1岁以下小儿不典型川崎病的诊断与治疗方法。方法选取2009年1月～2013年12月在本院心内科进行住院治疗的不典型川崎病患者共60例，男39例，女21例，年龄均＜1岁。另选择同期治疗的典型川崎病患者30例作为对照组，月龄（9．8±0．1）个月，比较两组患者临床表现差异，影像学和实验室诊断差异，观察治疗效果。结果60例不典型川崎病患者，均符合诊断标准中I项人数为6例，符合2项人数为30例，符合3项人数为20例，符合4项人数为3例，符合超过4项者1例。心脏彩超结果发现，心脏血流异常38例（63．3％），冠脉扩张43例（71．6％），冠状动脉增厚17例（28．3％）；X线片结果显示，肺纹理增粗35例（58．3％），肺野斑点12例（20，0％），其他13例（21．7％）。通过一段时间的治疗后发现，0．5～5d均发热消退；心脏彩超检测显示，冠脉扩张人数降低到13例（21．6％），与治疗前比较有显著性差异（x^2=4．13，P=0．035）；超声心动图显示冠状动脉均有不同程度的恢复；X片显示肺纹理增粗和肺野斑点人数明显下降，与治疗前比较有显著性差异（x^2=8．06，P=0．001）；实验室检查各项指标均有明显改善，与治疗前比较有显著性差异（P＜0．05），患儿平均住院（9．1±1．2）d。结论1岁以下不典型川崎病患儿的临床表现不明显，与典型川崎病具有明显区别，通过影像学和实验室检测可以辅助诊断。经过治疗后，可以达到较好的治疗效果。

Diagnosis and treatment of children under 1 year of atypical Kawasaki disease

Objective To investigate the diagnosis and treatment of children under 1 year of atypical Kawasaki dis ease. Methods 60 patients with atypical Kawasaki disease patients aged〈1 year including 39 males and 21 females were studied controlled with of 30 patients with typical Kawasaki disease The clinical presentation, diagnostic imaging and laboratory differences were observed. Results Of 60 patients with atypical Kawasaki disease, there were 6 cases with 1 i tern of diagnostic criteria, 30 cases with 2 items of diagnostic criteria, 20 cases with 3 items of diagnostic criteria and 3 eases with 4 items of diagnostic criteria. The echocardiography results showed that 38 cases （63.3%） with tubular expansion, 43 cases （63.3%） with eehoeardiography and 17 cases （19.4%） with coronary artery thickening . X -ray re suits showed 35 cases （58.3 %） with markings thickening and 12 patients （20.0 %） with lung spots. The fever subsided 0.5 to 5 days after treatment. There were 13 cases （21.6%） with tubular expansion after treatment. The echocardiographic examination showed varying degrees of coronary artery restored. X ray showed lung markings thickening and decreased the number of lung spots. The laboratory indicators showed significant improvement. The average length of stay of children was 14.1 ±2. ld. Conclusion The clinical manifestations of atypical Kawasaki disease in children has clear distinctions of imaging and laboratory tests between typical Kawasaki disease.