川崎病早期诊断与鉴别诊断6年临床研究.docVIP

川崎病早期诊断和鉴别诊断6年临床研究 全网发布：2011-06-23 01:43 发表者：徐灵敏(访问人次：2019) 来源：中国综合临床,2007,23(10):953-955. 川崎病早期诊断和鉴别诊断6年临床研究徐灵敏 栾斌 朱艳玲 贾丽婷 张 展作者单位：郑州大学第三附属医院儿内科（徐灵敏、栾斌）；检验科（朱艳玲、贾丽婷、张 展） 摘 要复旦大学附属中山医院青浦分院儿科徐灵敏 目的 研究川崎病（KD）患儿的临床特点, 以提高其早期诊断率。方法 采用前瞻性临床观察研究方法，分析了我院6年来收治的67例KD患儿的住院构成比及入院时临床表现和实验室检查，并与329例败血症患儿进行了对比。结果 KD诊断标准中的6种临床表现及肛周变化在KD中的出现率均显著高于败血症，而精神差、循环差、肝脾大及局灶感染征的出现率在败血症中均显著高于KD（P均＜0.01）。球蛋白升高、ESR增快、血小板升高在KD中的出现率均显著高于败血症，血培养阳性率在败血症中显著高于KD（P均＜0.01）。结论 早期诊断KD，临床医师认真仔细的病史问诊和体格检查是关键因素，还需进一步寻找特异性强的诊断指标。 6 years clinical study on early diagnosis and differential diagnosis of Kawasaki disease. Xu Lingmin , Luan Bin, Zhu Yanling , et al. Department of Pediatrics, the Third Affiliated Hospital of Zhengzhou University( Zhengzhou 450052, china) [Abstract] Objective To study the clinical characteristics, early diagnosis and differential diagnosis of children with Kawasaki disease (KD). Methods A prospective , observational clinical study . The hospitalization constituent ratios , clinical manifestations and laboratory investigations on admission of 67 Children with KD and 329 cases with septicemia in 6 years were analyzed . Results The incidences of the six principal clinical findings in diagnostic criteria for KD and peri-anus desquamation in infants with KD were significantly higher than that in infants with septicemia (P＜0.01). The incidences of drowsiness , poor circulation function, hepatosplenomegaly, focus infection sign in infants with KD were significantly lower than that in infants with septicemia (P＜0.01). Conclusions In order to diagnose KD early, the key factor is the clinician, s careful findings from history , observation and examination , and the more specific diagnostic criteria need to be investigated . [key words] Kawasaki disease ; Children；diagnosis; septicemia 川崎病（Kawasaki disease，KD）即皮肤粘膜淋巴结综合征,是一种迄今病因未明的急性发热、出疹性疾病,目前已取代风湿热成为儿童获得性心血管病的首要病因，而且幼年患 KD是成人后动脉粥样硬化和缺血性心脏病发生的危险因素之一[1-4]。KD缺乏特异性的临床表现和特征性的实验室检测指标,其诊断主要根据临床表现,并需排除败血症、幼年类风湿性关节炎全身型（简称类风湿）及风湿热等疾病的可能性[1,2]。为