川崎病合并巨大冠状动脉瘤101例中长期随访

目的总结分析川崎病合并巨大冠状动脉瘤(GCAA)患儿的临床特点及中长期预后。方法回顾性队列研究。自首都医科大学附属北京儿童医院2004年建立的川崎病冠状动脉瘤随诊患儿队列中选择符合标准的101例GCAA患儿进行总结。GCAA诊断标准为冠状动脉瘤内径≥8.0 mm,患儿均完成定期随诊。随访终点为患儿最后一次随诊或死亡时间。组间比较采用t检验或χ²检验。结果101例符合纳入标准GCAA患儿入选研究对象,其中男82例(81.2%)、女19例(18.8%);发病年龄2.5(1.0,4.5)岁,随访时间4.5(2.7,7.5)年,最长19年。患儿常规接受阿司匹林、华法林治疗,严重者另加氯吡格雷。截至随访终点,13例(12.9%)患儿出现心脏增大,11例(10.9%)合并心功能不全,13例(12.9%)发生心肌梗死,2例(2.0%)接受冠状动脉搭桥术,6例(5.9%)死亡。受累冠状动脉共170支,位于左侧主干24支(14.1%),左回旋支10支(5.9%),左前降支57支(33.5%),右侧冠状动脉中段78支(45.9%),右侧冠状动脉远段1支(0.6%)。11例(10.9%)患儿GCAA内径回缩至4.0 mm及以下;受累的170支冠状动脉中,28支(16.5%)冠状动脉内径回缩到4.0 mm及以下。左侧、右侧GCAA回缩情况差异无统计学意义[18.7%(17/91)比13.9%(11/79),χ²=2.473,P=0.116]。单侧GCAA与双侧GCAA患儿回缩情况差异无统计学意义[16.1%(9/56)比4.4%(2/45),χ²=2.381,P=0.123]。结论川崎病GCAA以右冠状动脉中段、左冠状动脉前降支最常见,患儿心血管事件发生率及病死率较高,预后欠佳。

Middle and long-term follow-up of 101 children with giant coronary artery aneurysm of Kawasaki disease

Objective To summarize the clinical features,middle-and long-term prognosis of Kawasaki disease(KD)with giant coronary artery aneurysm(GCAA).Methods In this retrospective cohort study,a cross-sectional analysis was conducted on 101 KD children with GCAA in the KD with GCAA database established by Beijing Children′s Hospital,Capital Medical University in 2004.GCAA was diagnosed as coronary artery absolute lumen diameter≥8.0 mm.All patients were followed up regularly.The endpoint was the time of last follow-up or the death time.T test or χ² test was used for comparison between groups.Results A total of 101 KD children with GCAA were enrolled,including 82 males(81.2%)and 19 females(18.8%).The age of disease onset was 2.5(1.0,4.5)years.The follow-up duration was 4.5(2.7,7.5)years,with a longest of 19 years.All children received routine treatment with aspirin and warfarin,and clopidogrel was added in severe cases.At the end of follow-up,13 cases(12.9%)had cardiac enlargement,11 cases(10.9%)developed heart failure,13 cases(12.9%)experienced myocardial infarction,2 cases(2.0%)underwent coronary artery bypass graft and 6 cases(5.9%)died.A total of 170 coronary arteries were involved,including 24(14.1%)GCAAs on the main trunk of left coronary artery,10(5.9%)GCAAs on left circumflex,57(33.5%)GCAAs on left anterior descending,78(45.9%)GCAAs on the middle segments of right coronary artery,and 1(0.6%)GCAA in the distal segments of right coronary artery.Eleven cases(10.9%)recovered with the coronary artery absolute lumen diameter of all GCAAs below 4.0 mm.Among 170 branches with GCAAs,28(16.5%)regressed below 4.0 mm.No significant difference was found in the regression rates between right and left GCAA(18.7%(17/91)vs.13.9%(11/79),χ²=2.473,P=0.116).There was no statistically significant difference in retraction between unilateral GCAA and bilateral GCAA(16.1%(9/56)vs.4.4%(2/45),χ²=2.381,P=0.123).Conclusions GCAA of KD occurred more common in the middle segments of right and left anterior descending coronary arteries.The incidence of adverse cardiac events and the mortality rate in children with GCAA complicated with KD was high.Their long-term prognosis was poor.