超声心动图和64层螺旋CT冠状动脉成像在川崎病冠状动脉瘤随访中的应用价值

目的探讨超声心动图和64层螺旋CT冠状动脉成像（64SCTCA）在川崎病（KD）冠状动脉瘤临床诊断和随访中的应用价值。方法选择2006年12 月至2007年5月在首都医科大学附属北京儿童医院门诊随访的KD并发冠状动脉瘤患儿作为研究对象。患儿观察终点随访时依据病变程度除行超声 心动图检查外，同时行64SCTCA检查，对各项检查结果进行详细描述，并分析其应用价值。结果研究期间纳入15例患儿，急性期KD超声心动图检 查显示急性期累及冠状动脉48/60支（80％）。患儿观察终点随访9个月至8.6年，平均（2.8±2.0）年，超声心动图示14/48支(29.2％)冠状动 脉瘤或扩张消退，其余进一步扩张或无明显变化，累及冠状动脉34/60支（56.7%），同时检测出2处血栓，未发现狭窄及钙化。64SCTCA示累及 冠状动脉30/60支（50％），主要累及右冠状动脉和左前降支，分布部位与超声心动图检查基本一致，64SCTCA与超声心动图检查对冠状动脉瘤 最大内径的测量值具有较好的相关性（r =0.837，P<0.001），64SCTCA发现4处血栓、5处钙化及3处狭窄。结论64SCTCA和超声心动图在KD并发 冠状动脉瘤患儿的随访中具有各自的应用价值，两种方法的联合应用可增加冠状动脉病变的检出率。

Value of echocardiography and 64-slice computed tomography coronary angiography in the follow-up of coronary artery aneurysms caused by Kawasaki disease

Objective Coronary artery lesions are critical in the long-term follow up of children with Kawasaki disease. Echocardiography is the most general imaging method and it is important to recognize the limitations of echocardiography in the evaluation of distal coronary artery aneurysm, thrombus and coronary artery stenosis. Recent years, technical advances of 64-slice computed tomography coronary angiography (64SCTCA) in evaluating coronary artery abnormalities and minimally invasive characteristics have led to the application in Kawasaki disease and got attention gradually. This study was to understand circumstances about the evolution and regression of coronary artery lesions and explore the value of 64SCTCA and echocardiography in clinical diagnosis and follow-up of coronary artery aneurysms caused by Kawasaki disease.MethodsFifteen patients with coronary artery aneurysms caused by Kawasaki disease followed in Beijing Children′s Hospital during Dec 2006 to May 2007 were selected. Diagnostic criteria of coronary artery aneurysm were defined coronary arteries as those with a lumen diameter >4 mm and 1.5 times the size of an adjacent segment. Fifteen patients underwent a regular follow-up after the onset of Kawasaki disease. They received an overall examination in hospital every half a year or one year, including the changes of clinical symptoms and physical signs and the results of electrocardiogram, echocardiography, treadmill exercises test, etc. In this study, all 15 patients underwent 64SCTCA and echocardiography examination. Then the examination findings were described and analyzed.ResultsEchocardiography in acute stage showed coronary artery lesions in 48 of 60 arteries(80%). Coronary aneurysms showed regression during follow-up in 75% arteries (2.8±2.0) years（9 months to 8.6 years）after the onset of Kawasaki disease. Further dilation or no changing of the arteries occurred in 25% arteries. Last studies showed coronary artery lesions in 34 of 60 arteries (56.7%). Echocardiography detected thrombi in 2 arteries. No stenosis and calcification were identified in follow-up period. 64SCTCA showed coronary artery lesions in 30 of 60 arteries (50%). The lesions mainly involved right coronary arteries (RCA) and left anterior descending arteries (LAD). 64SCTCA identified similar sites of coronary lesion as compared to echocardiography. A statistically significant correlation was observed between maximal diameter of coronary artery aneurysms by 64SCTCA and echocardiography (Pearson coefficient r =0.837, P<0.001). 64SCTCA detected thrombi at 4 sites, calcification at 5 sites and stenosis at 3 sites.Conclusions64SCTCA and echocardiography had respective application value in long-term follow-up of coronary artery aneurysms resulting from Kawasaki disease. Combined application of two diagnostic methods could increase the detectable rate of pathological changes.