川崎病并发冠状动脉损害的危险因素及预后分析

目的 探讨川崎病（Kawasaki disease,KD）并发冠状动脉损害（CAL）的危害因素及预后。方法 对402例KD患儿的临床资料进行回顾性分析，对比未并发CAL的382例A组KD患儿和并发CAL的21例B组DK患儿的相关检验、治疗及随访结果。结果 两组患儿在性别及年龄比例上差异无显著性（P＞0.05），B组患儿平均热程、血小板（PLT）、C反应蛋白（CRP）及血沉（ESR）值明显高于A组（P＜0.05）。急性期约30％的KD患儿伴有心肌酶谱、肌钙蛋白Ⅰ、心电图或超声心动图的异常。A组患儿在≤10d内静脉滴注丙种球蛋白（IVIG）的占85.08%，B组仅占28.57%。超声心动图随访19例并发CAL的患儿，5例冠状动脉扩张（CAD）于短期恢复正常；11例冠状动脉瘤（CAA）有9例恢复或好转；3例巨大冠状动脉瘤（GCAA）回缩困难。结论 热程过长及未予静脉注射两种球蛋（IVIG）治疗是KD并发CAL最重要的危险因素，同时表现有PLT、ESR及CRP的显著升高。部分KD患者伴一过性心肌炎、心包炎或心内膜炎。KD并发CAA及CAD可好转或痊愈并发GCAA的预后不良。

Analyses on risk factors and prognosis for coronary artery lesions secondary to Kawasaki disease

Objective To investigate the risk factors and prognosis on children with coronary artery lesions (CAL) secondary to Kawasaki disease (KD). Methods Clinical data including test results, therapeutic methods and prognosis were analyzed retrospectively in 403 patients with KD. Among them, 382 cases were without CAL (group A) and 21 cases with CAL (group B). Results Their sexes and ages were not statistically significant( P >0.1). But the duration of fever, mean value of platelets (PLT), erythrocyte sedimentation rate (ESR) and C reactive protein(CRP) in group B were higher than those in group A( P <0.05). About 30% patients had abnormal CK MB, cTnI, ECG or UCG in acute phase. About 85.08% cases of group A received intravenous immune globulin (IVIG) within 10 d from onset, while 28.57% in group B. CAL were observed on echocardiogram in 19 patients, 5 cases developing coronary artery dilatation(CAD)recovered in short time; In 11 cases with coronary artery aneurysm(CAA), 9 cases recovered or improved; 3 cases with giant coronary artery aneurysm(GCAA)rebounded difficultly. Conclusion Long time of fever and no IVIG treatment were the main risk factors of CAL secondary to KD, high values of PLT, ESR and CRP presenting concurrently. Some patients with KD might develop ephemeral myocarditis, pericarditis or endocarditis. CAD and CAA could recover or improve, GCAA appeared to have a poor prognosis.