不完全川崎病的临床表现特点分析

Clinical Characteristics Analysis of Incomplete Kawasaki Disease

摘要: 川崎病(Kawasaki disease, KD)属于一种病因尚未完全阐明的急性自限性血管炎症，好发于5岁以下的儿童，最让人担心的是它会伤害冠状动脉。若患儿符合的典型主要临床表现不足4条，便可诊断为不完全川崎病(incomplete Kawasaki disease, IKD)。IKD在临床上的难点在于发热可能作为唯一突出表现，结膜充血、皮疹、肢端脱屑、颈部淋巴结肿大等主要体征要么缺位，要么先后出现且表现不典型，导致其极易与麻疹、腺病毒感染或幼年特发性关节炎混淆。更为严重的是，IKD具有较高的冠状动脉损伤风险，漏诊后可能遗留心脏后遗症。因此，系统梳理IKD的临床特征具有明确的必要性和紧迫性。本综述围绕上述问题，回顾分析了近年来有关IKD的流行病学特点、临床表现、实验室检查、影像学改变及治疗反应，旨在提升儿科医生对该病的识别能力，减少误诊漏诊，改善患儿预后。

Abstract: Kawasaki disease (KD) is an acute self-limiting vasculitis of unknown etiology, predominantly affecting children under 5 years of age, with coronary artery injury being its most serious complication. When a patient presents with fewer than four of the typical major clinical manifestations, the condition is diagnosed as incomplete Kawasaki disease (IKD). The clinical challenge of IKD lies in the fact that fever may be the sole prominent feature, while other cardinal signs, such as conjunctival injection, rash, extremity desquamation, and cervical lymphadenopathy, are either absent or appear sequentially with atypical presentations. This often leads to misdiagnosis with measles, adenovirus infection, or juvenile idiopathic arthritis. More critically, IKD carries a high risk of coronary artery damage, and delayed diagnosis may result in long-term cardiac sequelae. Therefore, a systematic review of the clinical characteristics of IKD is both necessary and urgent. This review summarizes recent findings on the epidemiological features, clinical manifestations, laboratory tests, imaging changes, and treatment response of IKD, aiming to enhance pediatricians’ ability to recognize the disease, reduce misdiagnosis and delayed diagnosis, and improve patient outcomes.