Yanagi Sadamitsu, Nomura Yuichi, Masuda Kiminori, Koriyama Chihaya, Sameshima Koji, Eguchi Taisuke, Imamura Mari, Arata Michiko, Kawano Yoshifumi
Department of Pediatrics, Kagoshima City Medical Association Hospital, Kagoshima, Japan.
Pediatr Int. 2008 Apr;50(2):179-83. doi: 10.1111/j.1442-200X.2008.02547.x.
Among typical patients with Kawasaki disease (KD), a few KD patients present with only fever and cervical lymphadenopathy at admission (KDL). These patients have a significant risk for misdiagnosis, delay in treatment for KD, and development of coronary artery abnormalities. Therefore, the development of an easy tool for early diagnosis in these patients is desirable.
Patients who presented with only fever and cervical lymphadenopathy at admission were studied. Of these, 14 patients were eventually diagnosed with KD (KDL) and 24 patients were successfully treated using antibiotics (control). KDL patients were significantly older than control patients (P > 0.022). Among the laboratory findings, neutrophil counts (P > 0.003), C-reactive protein (CRP; P < 0.001), and aspartate aminotransferase (AST; P > 0.018) were significantly different between the groups. To discriminate KDL patients from controls, cut-off points of the aforementioned parameters (KDL indices) were determined using the receiver operating characteristic curves in order to maximize sensitivity and accuracy (age, 5.0 years; neutrophil counts, 10,000 /microL; CRP, 7.0 mg/dL; AST, 30 IU/L). One point was assigned if a subject exceeded the cut-off point in a KDL index. If a patient with three or four KDL indices was considered to have KD, the sensitivity was 78% and the specificity 100%. None of the patients with one or zero KDL index developed KD.
KDL indices may be helpful in discriminating KDL from lymphadenitis at admission. It is important to monitor the symptoms of KD in a patient with three or four KDL indices at admission.
在典型的川崎病（KD）患者中，少数KD患者在入院时仅表现为发热和颈部淋巴结肿大（KDL）。这些患者有被误诊、KD治疗延迟以及发生冠状动脉异常的重大风险。因此，开发一种针对这些患者的早期诊断简易工具很有必要。
对入院时仅表现为发热和颈部淋巴结肿大的患者进行研究。其中，14例患者最终被诊断为KD（KDL），24例患者使用抗生素成功治疗（对照组）。KDL患者明显比对照组患者年龄大（P>0.022）。在实验室检查结果中，两组之间中性粒细胞计数（P>0.003）、C反应蛋白（CRP；P<0.001）和天冬氨酸转氨酶（AST；P>0.018）有显著差异。为了区分KDL患者和对照组，使用受试者工作特征曲线确定上述参数（KDL指标）的截断点，以最大化敏感性和准确性（年龄，5.0岁；中性粒细胞计数，10,000/微升；CRP，7.0毫克/分升；AST，30国际单位/升）。如果受试者超过KDL指标的截断点，则给予1分。如果有三或四个KDL指标的患者被认为患有KD，敏感性为78%，特异性为100%。没有一个有一个或零个KDL指标的患者发生KD。
KDL指标可能有助于在入院时区分KDL和淋巴结炎。对入院时有三或四个KDL指标的患者监测KD症状很重要。
