Abstract: Background　Kawasaki disease shock syndrome （KDSS） is a rare disease that has similar clinical presentations in the early onset as sepsis shock，which confuses physicians often.Objective　To comparatively analyze the early clinical features of KDSS and septic shock in children，to provide a reference for pediatricians to effectively distinguish the two diseases.Methods　Eligible pediatric KDSS patients（n=15） and pediatric septic shock patients （n=21） were recruited from Hebei Children's Hospital Affiliated to Hebei Medical University during May 2015 to May 2018.Data of all of them were retrospectively collected and analyzed，including general information （gender，age，length of stay in the PICU，results of bacterial culture），laboratory indices 〔WBC，neutrophil fraction，hemoglobin，platelet count，albumin，CRP，PCT，ESR，ALT，AST，troponin I （TnI），CK-MB〕within 24 hours after admission，echocardiographic indices 〔left ventricular ejection fraction （LVEF），LVEF < 50%，mitral regurgitation，tricuspid regurgitation，coronary artery damage〕，ECG indices （sinus tachycardia，sinus bradycardia，supraventricular tachycardia，ventricular extrasystole，atrial extrasystole，atrioventricular block，ST-T change，PR interval prolongation） and prognosis（death at the end point of 28 days after the admission of PICU）.Results　There were no significant differences between the two groups in sex ratio，mean age，mean length of stay in the PICU，positive rate of bacterial culture and mortality（P>0.05）.There were also no significant differences in WBC，neutrophil fraction，albumin，CRP，PCT，ESR，ALT，AST，cTnI，and CK-MB between the two groups （P>0.05），but the mean value of hemoglobin was higher and that of platelet count was lower in the septic shock group （P<0.05）.There were no significant differences in LVEF，ratio of LVEF<50% and incidence of mitral regurgitation，sinus tachycardia，sinus bradycardia，supraventricular tachycardia，ventricular extrasystole，atrial extrasystole，atrioventricular block，ST-T change，prolonged PR interval between the two groups （P>0.05）.However，the incidence of tricuspid regurgitation and coronary artery damage in the KDSS group was higher than that in the septic shock group （P<0.05）.Conclusion　The specific manifestations of KDSS compared with septic shock include relatively higher hemoglobin，lower platelet count，and higher incidence of tricuspid regurgitation and coronary artery damage in children，which deserve clinical attention.

Key words: Kawasaki disease；Kawasaki disease shock syndrome；Shock, septic；Disease attributes；Diagnosis, differential；Comparative study

摘要： 背景　川崎病休克综合征（KDSS）临床少见，但其与脓毒性休克有相似的临床表现，发病早期常难以鉴别诊断。目的　对比分析儿童KDSS与脓毒性休克早期主要临床特征，为儿科医生有效区分两种疾病提供可参考的临床数据。方法　选取2015年5月—2018年5月河北医科大学附属河北省儿童医院收治符合研究标准的KDSS患儿15例及脓毒性休克患儿21例，分别记为KDSS组和脓毒性休克组。回顾性分析KDSS和脓毒性休克患儿基本资料〔性别、年龄、儿童重症医学科（PICU）入住时间、细菌培养结果〕和入院24 h内实验室检查指标〔白细胞计数（WBC）、中性粒细胞分数、血红蛋白（Hb）、血小板计数（PLT）、白蛋白、C反应蛋白（CRP）、降钙素原（PCT）、红细胞沉降率（ESR）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、肌钙蛋白（Tn）I和肌酸激酶同工酶（CK-MB）〕、超声心动图检查指标〔左心室射血分数（LVEF）、LVEF<50%、左房室瓣反流、右房室瓣反流、冠状动脉损伤〕、心电图检查指标（窦性心动过速、窦性心动过缓、室上性心动过速、室性期前收缩、房性期前收缩、房室传导阻滞、ST-T改变、PR间期延长）及预后情况。以收入PICU起28 d为研究终点，统计患儿死亡情况。结果　KDSS组与脓毒性休克组患儿性别、年龄、PICU入住时间、细菌培养阳性率、死亡率比较，差异无统计学意义（P>0.05）。KDSS组与脓毒性休克组患儿WBC、中性粒细胞分数、白蛋白、CRP、PCT、ESR、ALT、AST、TnI、CK-MB比较，差异无统计学意义（P>0.05）；脓毒性休克组患儿Hb高于KDSS组，PLT低于KDSS组（P<0.05）。KDSS组和脓毒性休克组患儿LVEF、LVEF<50%者所占比例、左房室瓣反流发生率、窦性心动过速发生率、窦性心动过缓发生率、室上性心动过速发生率、室性期前收缩发生率、房性期前收缩发生率、房室传导阻滞发生率、ST-T改变发生率、PR间期延长发生率比较，差异无统计学意义（P>0.05）；KDSS组患儿右房室瓣反流发生率、冠状动脉损伤发生率高于脓毒性休克组（P<0.05）。结论　儿童KDSS相比脓毒性休克的特异表现包括相对升高的Hb、相对降低的PLT、相对较高的右房室瓣反流和冠状动脉损伤发生率，值得临床关注。

关键词: 川崎病；川崎病休克综合征；休克, 脓毒性；疾病特征；诊断, 鉴别；对比研究