Sittiwangkul Rekwan, Pongprot Yupada, Silvilairat Suchaya, Makonkaewkeyoon Krit
Chiang Mai University Hospital, Thailand.
Paediatr Int Child Health. 2013 Aug;33(3):176-80. doi: 10.1179/2046905513Y.0000000062.
Inadequate diagnostic criteria in incomplete Kawasaki disease (KD) patients may lead to misdiagnosis and delayed treatment. However, the risk of coronary artery aneurysm in these patients remains uncertain.
To investigate differences in clinical, laboratory and echocardiographic variables between patients with incomplete KD and classic KD.
The medical records of 208 KD patients treated between January 2001 and December 2009 in the Department of Pediatrics, Chiang Mai University Hospital were reviewed retrospectively. Patients with three or fewer major criteria were defined as having incomplete KD.
Of the 208 KD patients, 61 (29%) had incomplete KD. In those with incomplete KD, a significantly higher proportion were male (73.8% vs 59.2%, P = 0.03), the diagnosis was made later [mean (SD) day 9.0 (4.2) vs 7.2 (2.5), P = 0.003], there was a higher rate of delayed diagnosis (>10 days, 21% vs 10%, P = 0.02) and the presence of five major criteria was less common. The proportion of associated symptoms (irritability, upper respiratory tract symptoms, diarrhoea, vomiting and reactivation of BCG) and laboratory findings (pyuria, haemoglobin level, white blood count, polymorphonuclear cells, platelet count, erythrocyte sedimentation rate and serum albumin) were comparable in patients with incomplete KD and classic KD. The incomplete KD group tended to have a higher proportion of coronary artery abnormalities but the difference was not statistically significant (38% vs 25%, P = 0.09). However, a significantly greater proportion of the group with incomplete KD had large aneurysms (10% vs 1%, P = 0.009).
Incomplete KD and classic KD have the same disease spectrum. Owing to the absence of some major criteria, incomplete KD can be more difficult to diagnose, which can result in delayed diagnosis and a greater risk of large coronary aneurysms.
不完全川崎病（KD）患者的诊断标准不完善可能导致误诊和治疗延迟。然而，这些患者发生冠状动脉瘤的风险仍不确定。
研究不完全KD患者与典型KD患者在临床、实验室及超声心动图变量方面的差异。
回顾性分析2001年1月至2009年12月在清迈大学医院儿科接受治疗的208例KD患者的病历。主要标准少于三项的患者被定义为不完全KD。
208例KD患者中，61例（29%）为不完全KD。在不完全KD患者中，男性比例显著更高（73.8%对59.2%，P = 0.03），诊断时间较晚[平均（标准差）第9.0（4.2）天对7.2（2.5）天，P = 0.003]，延迟诊断率更高（>10天，21%对10%，P = 0.02），且五项主要标准的出现较少见。不完全KD患者与典型KD患者的相关症状（烦躁、上呼吸道症状、腹泻、呕吐及卡介苗再激活）及实验室检查结果（脓尿、血红蛋白水平、白细胞计数、多形核细胞、血小板计数、红细胞沉降率及血清白蛋白）比例相当。不完全KD组冠状动脉异常比例倾向于更高，但差异无统计学意义（38%对25%，P = 0.09）。然而，不完全KD组大动脉瘤的比例显著更高（10%对1%，P = 0.009）。
不完全KD与典型KD具有相同的疾病谱。由于缺乏一些主要标准，不完全KD可能更难诊断，这可能导致诊断延迟及发生大冠状动脉瘤的风险更高。
