Department of Public Health, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Eur J Pediatr. 2012 Apr;171(4):651-6. doi: 10.1007/s00431-011-1630-3. Epub 2011 Dec 10.
Incomplete Kawasaki disease (KD) is associated with delayed diagnosis and treatment, which in turn can lead to the development of coronary artery lesions (CALs). The aim of this study was to determine the epidemiological features of incomplete KD compared with complete KD and to identify risk factors for CALs from incomplete KD patients using data from a nationwide survey of 2007-2008 in Japan. A total of 23,263 patients were classified according to the number of principal clinical signs: 80% (n = 18,620) had complete forms of KD, 14.2% had four principal signs, 4.6% had three signs, and 1.2% had only one or two signs. In comparison with complete KD cases, the prevalence of CAL development tended to be larger and the proportion receiving initial intravenous immunoglobulin (IVIG) treatment were significantly smaller in patients with incomplete forms. In addition, hospital attendance after 7 days of illness or later was significantly associated with CAL development in all incomplete groups (OR: 2.52 in total patients with incomplete KD, 3.26 in those with one or two principal signs, 2.94 in those with three signs, 2.35 in those with four signs).
The higher prevalence of CALs in incomplete KD reflects difficulties in diagnosis and delays in treatment. More timely diagnosis and treatment of incomplete KD patients could further prevent the development of cardiac lesions.
不完全川崎病（KD）与诊断和治疗的延迟有关，这反过来又可能导致冠状动脉损伤（CALs）的发展。本研究的目的是确定不完全 KD 与完全 KD 的流行病学特征，并使用日本 2007-2008 年全国调查的数据，确定不完全 KD 患者发生 CALs 的危险因素。共有 23263 名患者根据主要临床体征的数量进行分类：80%（n=18620）为完全型 KD，4.6%为三主征，14.2%为四主征，1.2%为仅一或二主征。与完全 KD 病例相比，不完全 KD 患者的 CAL 发生率往往更高，且接受初始静脉注射免疫球蛋白（IVIG）治疗的比例明显更小。此外，所有不完全组中，发病后 7 天及以后就诊与 CAL 发展显著相关（OR：不完全 KD 患者总数为 2.52，一或二主征患者为 3.26，三主征患者为 2.94，四主征患者为 2.35）。
不完全 KD 中 CALs 发生率较高反映了诊断困难和治疗延迟。更及时地诊断和治疗不完全 KD 患者可能进一步预防心脏损伤的发生。
