单次静脉输注丙种球蛋白治疗川崎病合并冠状动脉病变的疗效观察

目的：观察单次静脉输注丙种球蛋白治疗川崎病（ KD）合并冠状动脉病变的临床疗效。方法将68例KD合并冠状动脉病变患者随机均分为A、B组各34例,均给予阿司匹林退热治疗,A、B组分别单次静脉输注丙种球蛋白2、1 g/kg,均在8～12 h内输完。记录两组治疗后冠状动脉血栓情况、冠状动脉直径变化、冠状动脉瘤发生情况和临床症状等。结果 A、B组治疗总有效率分别为61．8％（21/34）和50．0％（17/34）。 A组治疗前后冠状动脉直径分别为（4．2±0．8）、（2．6±0．5）mm,P＜0．05;B组治疗前后冠状动脉直径分别为（4．4±0．7）、（3．0±0．7） mm,P＜0．05;治疗后B组冠状动脉直径大于A组（P＜0．05）。 A组出现动脉血栓2例（5．9％）,B组未出现血栓异样;两组均未出现巨大冠状动脉瘤。两组总发热时间、淋巴结肿大消退时间、充血与水肿消退时间差异均无统计学意义（P均＞0．05）结论首次静脉丙种球蛋白能减小KD合并冠状动脉病变患者冠状动脉直径,明显改善病情,但剂量增大可能会增大血液黏度,增加形成血栓的风险。     

川崎病冠状动脉损伤患儿血清可溶性人基质裂解素2的浓度及临床意义

目的 探讨川崎病（Kawasaki disease,KD）冠状动脉损伤（coronary artery lesion,CAL）患儿血清可溶性人基质裂解素2(soluble suppression of tumorigenicity-2,ST2)的浓度及临床意义。方法 回顾性分析自贡市第四人民医院2018年10月至2019年12月的155例川崎病患儿的临床资料,分为CAL组（n=56）和无CAL组（n=99）;另选取健康儿童30名为对照组。比较3组研究对象血清sST2浓度及常规实验指标如C反应蛋白（C-reactive protein,CRP）浓度、白细胞（white blood cell,WBC）计数、红细胞沉降率（erythrocyte sedimentation rate,ESR）、白蛋白浓度、血小板计数等资料的差异。结果 与对照组比较,NCA组和CAL组患者血清sST2、CRP浓度及WBC计数、ESR均显著增高,而血清白蛋白浓度、血小板计数均显著降低,差异有统计学意义（P<0.05）;非CAL组与CAL组患儿上述指标比较,差异均有统计学意义（P<0.05）。Logis...     

血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的相关性

目的探讨血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的关系。方法选择因心绞痛行冠状动脉造影的2型糖尿病患者197例,根据造影结果,冠状动脉正常为对照组(n=89),冠状动脉病变为冠心病组(n=108)。根据冠状动脉病变支数分为单支病变、双支病变和三支病变;Gensini积分评价冠状动脉病变狭窄程度。ELISA测定血清YKL-40和高敏C反应蛋白水平(hs-CRP)。结果冠心病组和对照组间血清YKL-40、hs-CRP、收缩压、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、脂蛋白(a)、餐后2 h血糖、糖化血红蛋白水平及吸烟率存在明显的差异(P<0.05)。不同冠状动脉病变支数组血清YKL-40水平和Gensini积分存在显著差异(P<0.01);血清YKL-40与Gensini积分存在明显相关性(r=0.611,P<0.01)。Logistic回归分析显示,血清YKL-40是2型糖尿病患者罹患冠心病的危险因素(OR=1.229,95%CI为1.086～1.427,P=0.003)。结论 YKL-40可能参与2型糖尿病粥样硬化的发生发展过程,血清YKL-40水平与2型糖尿病患者冠状动脉病变的严重性相关。     

血清APN和NT-proBNP在川崎病患儿冠状动脉病变早期诊断中的意义

目的探讨血清脂联素(APN)及N末端B型利钠肽原(NT-proBNP)在川崎病患儿冠状动脉病变中的早期诊断价值。方法选择山西省儿童医院2018年10月—2019年10月入院的100例川崎病患儿(川崎病组),其中,冠状动脉病变22例,无冠状动脉病变78例,另随机选取40名健康儿童作为对照组。检测并分析血清APN、NT-proBNP、肌钙蛋白I(cTnI)水平的变化。结果川崎病组患儿血清APN水平低于对照组(P<0.05),血清NT-proBNP、cTnI水平高于对照组(P<0.05)。川崎病组患儿急性期血清APN水平低于恢复期(P<0.05),血清NT-proBNP、cTnI水平高于恢复期(P<0.05)。在急性期与恢复期,冠状动脉病变组血清APN、NT-proBNP、cTnI水平均高于无冠状动脉病变组(P<0.05)。结论APN、NT-proBNP是川崎病患儿并发冠状动脉病变的危险因素,APN和NT-proBNP有望作为识别川崎病患儿冠状动脉早期损伤的指标。     

老年冠心病患者炎症因子水平与冠状动脉病变严重程度的相关性

炎症反应在动脉粥样硬化形成、发生、发展中起着重要的作用,而慢性、低度炎症是动脉粥样硬化发生、发展的一个重要因素。炎症标志物如高敏C反应蛋白(hs-CRP)作为一种系统炎症的敏感指标,能独立预测冠状动脉事件发展的危险度。本实验通过检测老年冠心病患者血清脂联素及hs-CRP水平,进一步分析其与冠心病患者冠状动脉病变之间的相关性,揭示脂联素及hs-CRP在动脉粥样硬化发生发展中的可能     

2型糖尿病患者凝血功能与血管病变的相关性分析

目的探究2型糖尿病(T2DM)患者凝血功能与血管病变的关系。方法选择2014年6月至2015年8月该院收治T2DM患者78例,根据患者疾病进展情况将其分为伴有血管病变患者45例为观察组,血糖控制较好、无血管病变患者33例为对照组,测定两组患者凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fg)、血糖(Glu)及糖化血红蛋白(Hb A1c)水平,分析各凝血指标与血糖控制水平的相关性,采用Logistic回归分析T2DM发生血管病变的危险因素。结果研究组患者Glu、Hb A1c、Fg水平均显著高于对照组,APTT、PT水平均显著低于对照组(P0.05);相关性分析显示,两组患者各项凝血指标与Glu和Hb A1c水平均不存在相关性(P0.05);多因素Logistic分析结果显示高水平Hb A1c(OR=1.23,P0.05)、Fg(OR=1.45,P0.05)是T2DM患者血管病变的危险因素;高水平APTT(OR=0.87,P0.05)是T2DM患者血管病变的保护因素。结论 T2DM发生血管病变患者出现凝血功能紊乱,其引起患者血管病变发生的重要因素,高水平Hb A1c、Fg及低水平APTT是T2DM患者血管病变的危险因素。     

血清骨钙素水平与冠状动脉病变程度及冠状动脉钙化的相关性研究

目的 探讨血清骨钙素水平与冠状动脉粥样硬化性心脏病(冠心病,CAD)患者冠状动脉(冠脉)病变程度及冠脉钙化的相关性.方法 选取柳州市人民医院心血管内科疑似CAD患者286例,具有完整资料的受试者作为整体研究,根据冠脉造影结果分为CAD组及Non-CAD组;对CAD患者行冠脉双源螺旋CT扫描,采用Agatston修正法计...     

Serum YKL-40 levels in patients with coronary artery disease

Atherosclerosis is considered to be an inflammatory disease in which the initial process is the augmented infiltration of monocytes into the vessel wall and their subsequent differentiation from macrophages into lipid-laden foam cells. Human cartilage glycoprotein-39 (YKL-40) is a new inflammatory marker found to be secreted by lipid-laden macrophages inside human atherosclerotic vessel wall. The aim of this study was to investigate the association of serum YKL-40 levels with the presence and extent of coronary artery disease (CAD) assessed by coronary angiography. We also studied the relation of high-sensitivity C-reactive protein with the presence and angiographic severity of CAD. A total of 200 participants undergoing to coronary angiography was divided into four subgroups: control patients without CAD (n=53), and those with one-vessel disease (n=52), two-vessel disease (n=47), or three-vessel disease (n=48). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. Both serum YKL-40 levels and high-sensitivity C-reactive protein concentrations in patients with CAD were significantly higher than in control participants (P<0.001). We also found a significant association between the levels of YKL-40 and the extent of CAD defined by the number of stenosed vessels (P<0.001). The relationship between the serum YKL-40 level and atherosclerosis may represent a new opportunity for the possible utility of serum YKL-40 as an inflammatory marker for coronary artery disease. Moreover, our findings revealed that plasma YKL-40 measurement might also be regarded as a quantitative indicator of disease extent besides being a marker of disease presence.     

Increased serum YKL-40 and C-reactive protein levels are associated with angiographic lesion progression in patients with coronary artery disease

Objective

YKL-40 is a pro-inflammatory protein highly expressed in atherosclerotic plaques, and is related to prognosis of patients with coronary artery disease (CAD). This study aimed to assess the possible association between YKL-40 and coronary lesion progression in CAD patients.

Methods

A total of 313 patients with CAD, who underwent percutaneous coronary intervention (PCI) and follow-up angiography (mean 13.2 ± 3.2 months) were recruited. Serum YKL-40 and high-sensitivity C-reactive protein (hsCRP) levels were measured using ELISA kits.

Results

Baseline serum YKL-40 and hsCRP levels were higher in those with lesion progression (all p < 0.001 vs. patients without lesion progression), and correlated significantly with change of lumen diameter stenosis and cumulative coronary obstruction score (all p < 0.01). Multivariable logistic regression analysis revealed that after adjusting for conventional risk factors, number of total coronary artery lesions, YKL-40 and hsCRP levels were independent determinants of lesion progression. An area under the curve of YKL-40 and hsCRP was 0.744 (CI 95% 0.685–0.804, p < 0.001) and 0.716 (CI 95% 0.657–0.776, p < 0.001), respectively. The optimal values of cut-off point were 74.98 ng/ml (sensitivity 70%, specificity 71%) for YKL-40 and 3.21 mg/l (sensitivity 66%, specificity 68%) for hsCRP to predict lesion progression.

Conclusion

Increased serum YKL-40 and hsCRP levels are independently associated with lesion progression in patients with CAD.     

Increased serum levels of YKL-40 in patients with inflammatory bowel disease

BACKGROUND AND AIMS: Initiation of a fibrotic process has been suggested as part of the intestinal response to chronic inflammation in inflammatory bowel disease. YKL-40 has been proposed as a new serum marker of fibrosis. We studied compared the serum levels of YKL-40 in patients with ulcerative colitis or Crohn's disease with inflammatory and healthy controls. PATIENTS AND METHODS: YKL-40 serum levels were measured in 179 patients with inflammatory bowel disease (94 ulcerative colitis, 85 Crohn's disease), in 23 with intestinal inflammation of other causes, and 70 matched healthy controls using a commercially available enzyme-linked immunosorbent assay. YKL-40 levels were assessed in terms of disease activity, type and localization. RESULTS: Mean serum YKL-40 levels were 102.6+/-82.7 ng/ml in ulcerative colitis patients and 112.2+/-83.7 ng/ml in Crohn's disease patients, significantly higher than in healthy controls (64.1+/-21.4 ng/ml) but not significantly different from inflammatory controls (77.8+/-23.1 ng/ml). Disease activity and C-reactive protein levels were significantly correlated with YKL-40 levels in both ulcerative colitis and Crohn's disease. Crohn's disease patients with ileum localization had significantly higher YKL-40 levels than those with ileocolonic or colonic disease. Patients with stenotic disease had mean YKL-40 levels not significantly different than those with nonstenotic disease. CONCLUSION: Serum levels of YKL-40 are increased in patients with inflammatory bowel disease, and this is associated with the inflammatory process rather than with the degree of fibrosis.     

冠心病患者血尿酸水平与冠状动脉病变程度的相关性分析

目的:探讨血清UA水平与冠状动脉病变严重程度的关系。方法:回顾性分析2011年6月至2012年6月,在我科住院行冠状动脉造影检查者408例。根据造影结果,分为冠状动脉正常组和冠心病组,并根据SYNTAX评分,将冠心病组分为低危组(1～22分)、中危组(23～32分)及高危组(>33分)。测定空腹UA水平、空腹血脂:包括TC、TG、HDL-C及LDL-C。比较各组患者血脂、血UA水平。男性UA以<416μmol/L为正常值,女性以<357μmol/L为正常值,再将患者分为高UA组和正常UA组,比较两组SYNTAX评分,并进行相关性分析。结果:SYNTAX评分高危组、中危组与正常组比较TC、LDL-C显著增高,而正常组、低危组间差异无统计学意义(P>0.05)。SYNTAX评分高危组、中危组与同性别冠状动脉正常组比较,血UA水平显著增高。正常UA组与高UA血症组在年龄、性别、TC、TG、HDL-C及LDL-C的差异无统计学意义(P>0.05)。高UA血症组患者的冠状动脉SYNTAX评分显著高于正常血UA组。多元Logistic回归分析表明血UA水平与冠状动脉病变程度相关。结论:血UA是冠状动脉病变严重程度的相关危险因素,随着血UA水平的增高,冠状动脉病变程度增加。     

Association between plasma inflammatory markers and morphology of coronary artery lesion in patients with coronary artery disease

The atherosclerotic plaque vulnerability may be related to inflammation,immunity,metabolism and blood clotting.One of the key factors affecting plaque stability is inflammatory reaction.This study was to investigate the relationship between vulnerability of coronary artery plaque evaluated with coronary angiography (CAG),intravascular ultrasound (IVUS) and the levels of plasma inflammatory markers.Methods Fifty-eight consecutive patients with acute coronary syndrome who had coronary lesion of a single vessel were divided into 3 groups based on angiographic morphology of the lesions:type Ⅰ lesion group (n =16),type Ⅱ lesion group (n =25) and type Ⅲ lesion group (n =17).The control group consisted of 17 patients with stable angina.Plasma levels of high sensitivity C reaction protein (hs-CRP),matrix metalloproteinase (MMP,including MMP-2 and MMP-9),CD40 ligand (CD40L) and pregnancy associated plasma protein-A (PAPP-A) were measured by ELISA.A subgroup of 28 patients (including 18 ACS patients and 10 stable angina control patients) who underwent IVUS study,were analyzed.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in type Ⅱ lesion group were significantly higher than those in other groups (all P＜0.05).In type Ⅱ lesion group,linear correlation analyses showed significant positive correlation between levels of hs-CRP and MMP-2 (r=0.508);MMP-2 and MMP-9,CD40L,PAPP-A (r=0.647,0.704 and 0.751,respectively);MMP-9 and CD40L,PAPP-A (r=0.491 and 0.639,respectively);CD40L and PAPP-A (r=0.896).IVUS subgroup analysis showed that the area of plaques and plaque burden in culprit lesion,the incidence of high-risk plaques,remodeling index (RI) and positive remodeling percentage in ACS patients were significantly greater than those in control subgroup (P=0.000,0.037,0.028,0.015 and 0.040,respectively).Compared with control subgroup,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated (P=0.033,0.000,0.000 and 0.027,respectively).Conclusions CAG and IVUS combined with study on plasma levels of inflammation mediators are helpful in judging the vulnerability of coronary artery plaques.(J Geriatr Cardiol 2008;5:207-211)     

冠心病合并亚甲状腺功能减低患者的临床和冠脉病变特点

目的:研究冠心病合并亚甲状腺功能减低患者的临床和冠脉病变特点。方法:随机选择我院58例冠心病患者分为两组:冠心病合并亚甲状腺功能减低组(冠心病亚甲减组,28例),冠心病无甲状腺功能减低组(冠心病组,30例),对比分析两组临床和冠状动脉造影资料。结果:冠心病亚甲减组合并高血压(57.1%),心肌梗死(35.7%),心力衰竭者(35.7%)比例明显高于冠心病组的(36.7%,10.0%,13.3%,P均<0.05);与冠心病组比较,冠心病亚甲减组甘油三酯[TG,(1.95±1.23)mmol/L比(3.32±1.20)mmol/L]、总胆固醇[TC,(3.50±1.15)mmol/L比(5.87±1.08)mmol/L]、低密度脂蛋白胆固醇[LDL-C,(2.87±0.74)mmol/L比(3.40±0.65)mmol/L]、脂蛋白(a)[LP(a),(200±33)mg/L比(275±35)mg/L]水平明显升高(P均<0.01),而高密度脂蛋白胆固醇[HDL-C,(1.20±0.52)mmol/L比(0.88±0.25)mmol/L]水平则明显降低(P<0.01),冠脉三支病变(13.3%比64.3%)、弥漫性(33.3%比78.6%)、重度(26.7%比53.6%)及闭塞(10.0%比32.1%)病变患者比例也明显升高(P<0.05或<0.01)。结论:冠心病合并亚甲状腺功能减低患者的特点是临床表现和冠脉病变更加严重。     

高血压合并冠心病患者血清periostin、AngII水平及其相关性

目的 探讨高血压合并冠心病患者血清骨膜素（periostin,PN）及血管紧张素Ⅱ（AngⅡ）水平及其临床意义。方法 选取2018年10月至2019年7月在山西医科大学第二医院就诊患者163例,分为原发性高血压合并冠心病（EH+CHD）组81例,原发性高血压（EH）组48例和正常对照组34例;其中EH+CHD组分为陈旧性心肌梗死（OMI）亚组（22例）,不稳定型心绞痛（UA）亚组（31例）,急性心肌梗死（AMI）亚组（28例）。比较各组研究对象血清PN、AngⅡ、总胆固醇（TC） 、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平变化并分析其相关性。结果 血清PN、AngⅡ、TC、TG、LDL-C水平在对照组、EH组及EH+CHD组三组间比较差异有统计学意义,且EH+CHD组>EH组>对照组 [PN：（1629.70±209.03）ng/L比（1774.20±230.22）ng/L比（1952.78±282.41）ng/L;Ang II:（403.52±23.56）ng/L比（579.87±52.36）ng/L比（605.54±67.38）ng/L;TC:（3.92±0.75）mmol/L比（3.95±0.89）mmol/L比（4.87±1.03）mmol/L;TG:(1.29±0.56) mmol/L比(1.49±0.57) mmol/L比(1.91±0.86) mmol/L;LDL-C:(2.27±0.69) mmol/L比(2.19±0.73) mmol/L比(2.67±0.77) mmol/L]（P<0.05）;血清HDL-C水平在对照组、EH组及EH+CHD组三组间比较差异有统计学意义,且EH+CHD组＜EH组＜对照组[HDL-C:(1.21±0.28) mmol/L比(1.13±0.27) mmol/L比(0.98±0.28) mmol/L]（P<0.05）。血清TC、TG、LDL-C及HDL-C水平除在对照组和高血压组无统计学意义（P>0.05）,在其余各组间两两比较差异均有统计学意义（P<0.05）。EH+CHD的三个亚组中,血清PN与AngⅡ水平各组之间两两比较均有统计学差异,且AMI组>UA组>OMI组[PN:（2131.88±303.95）ng/L比（1955.60±196.48）ng/L比（1720.84±175.38）ng/L;Ang II:（646.41±78.86）ng/L比（602.59±47.88）ng/L比（557.68±37.21）ng/L]（P<0.05）。Pearson相关性分析,血清PN与AngⅡ、TC 、TG、LDL-C水平呈正相关关系（rAngⅡ=0.580,rTC=0.338,rTG=0.384,rLDL-C=0.318,P<0.05）,血清PN与HDL-C水平呈负相关关系（rHDL-C=-0.320,P<0.05）。结论 血清periostin水平与冠心病及高血压密切相关,联合检测PN和AngⅡ可以更好的反映高血压合并冠心病患者疾病的严重程度;PN可能是高血压合并冠心病治疗的靶点。     

冠心病患者肾功能与冠状动脉病变程度的关系

目的 探讨冠心病患者肾功能与冠状动脉病变程度的关系.方法 根据基础肾小球滤过率（GFR）将连续299例接受冠状动脉造影患者分为3组：肾功能正常组144例,GFR〉90 ml/（min×1.73m2）;肾功能轻度减退组97例,GFR 60～89ml/（min×1.73 m2）;肾功能中度减退组58例,GFR〈60ml/（min×1.73 m2）;再分别根据入院检查的尿常规（0、微量、1＋、2＋、3＋）将患者分为2组：尿蛋白阴性组171例,尿蛋白阳性组128例,比较各组间的临床特点及冠状动脉病变情况.结果 随着肾功能减退及蛋白尿的产生,冠心病发生率（66.7%、70.1%和72.4%,P〈0.05,64.2%和75.0%,P〈0.05）增高,多支血管病变明显增多,冠状动脉病变积分[（15.0＋14.7）、（19.0±20.0）和（22.0±21.2）,（15.2±16.0）和（20.4±20.2）]增高.结论 慢性肾功能减退及蛋白尿是冠状动脉病变的危险因素,尤其在肾脏受损的早期蛋白尿检查更加重要.     

The relation of serum gamma-glutamyl transferase levels with coronary lesion complexity and long-term outcome in patients with stable coronary artery disease

BackgroundRelation of serum gamma-glutamyl transferase (GGT) levels with extent, severity, and complexity of coronary artery disease has not been adequately studied. Therefore, we evaluated the relationship between GGT levels and coronary complexity, severity and extent assessed by SYNTAX score and long-term adverse events.MethodsWe enrolled 442 consecutive patients with stable angina pectoris who underwent coronary angiography. Baseline serum GGT levels were measured and SYNTAX score was calculated from the study population. Median follow-up duration was 363 days. Endpoints were all cause mortality and any revascularization.ResultsGGT levels demonstrated an increase from low SYNTAX tertile to high tertile. In multivariate analysis serum GGT, diabetes mellitus, HDL-cholesterol, eGFR and ejection fraction were found to be independent predictors of high SYNTAX score. The survival analysis showed that long-term revascularization rates were comparable between the GGT groups (for 36 U/l cut point) of the overall population (7.7% vs 8.6% logrank, p = 0.577), whereas long-term all cause mortality rate was higher in the GGT ≥ 36 U/l group (3.6% vs 11.6% logrank, p = 0.001). In Cox proportional hazards regression model, GGT ≥ 36 U/l group was found to be an independent predictor of long-term all cause mortality in the unadjusted (HR 2.54, 95% CI 1.17–5.48, p = 0.018) and age- and gender-adjusted (HR 2.58, 95% CI 1.19–5.58, p = 0.016) models.ConclusionSerum GGT level was independently associated with coronary complexity and long-term mortality in patients with stable coronary artery disease.     

超声随访川崎病并发冠状动脉病变的3年分析

目的 探讨川崎病并发冠状动脉病变患儿的预后,为进一步探索川崎病引起心血管损害后期的诊断治疗提供依据.方法 选取2002年1月至2007年6月在桂林医学院附属医院、广西壮族自治区第二人民医院及桂林市妇女儿童医院诊断为川崎病并发冠状动脉损害的患儿为研究对象.所有纳入者均于急性期出院后3、6个月和1、2、3年各随访超声心动图1次,观察冠状动脉形态.依据发病时冠状动脉损害严重程度分为冠状动脉轻度扩张组、中等动脉瘤组和巨大冠状动脉瘤组,对其病变恢复情况进行比较.结果 冠状动脉轻度扩张组84例,中等动脉瘤组27例,巨大冠状动脉瘤组8例获得随访.随访3个月,3组恢复例数分别为23例(27%)、3例(11%)、0;6个月时分别为44例(52%)、8例(30%)、0;1年时分别为69例(82%)、13例(48%)、1例(13%);2年时分别为78例(93%)、19例(70%)、3例(38%);3年时分别为82例(98%)、20例(74%)、4例(50%).其中13例行三磷酸腺苷(ATP)负荷超声心动图检查,5例行冠状动脉造影,4例行 64排CT冠状动脉重建,发现部分病例存在冠状动脉狭窄或冠状动脉闭塞.结论 川崎病最常见的是冠状动脉扩张,轻度冠状动脉扩张多见且多是暂时性的,通常在治疗后能恢复.巨大冠状动脉瘤比例低,但恢复时间长,后期可发生冠状动脉狭窄或闭塞,导致缺血性心脏病概率更高.对于川崎病,尤其是冠状动脉病变严重者应加强随访,及时干预治疗,以期改善预后.

Abstract：

Objective To investigate the prognosis of patients with Kawasaki's disease complicated with coronary artery lesion and to provide evidence for diagnosis and treatment of these patients. Methods This study was conducted during January 2002 to June 2007. All patients diagnosed as Kawasaki's disease complicated with coronary artery lesions were from the Affiliated Hospital of Guilin Medical College, the Second People's Hospital of Guangxi Province and Guilin Women and Childrens' Hospital. All cases were echocardiogram examined in month 3, 6, 12, 24 and 36 in the purpose of observing the morphology of coronary artery. The study subjects were re-categorized to the groups of mild, moderate dilatation of coronary artery and giant coronary aneurysm, based on the severity of coronary artery lesion. The results of these results of the three groups were compared. Results Eighty-four cases in the mild group, 27 cases in the moderate group and 8 cases in the giant coronary aneurysm. The recovery cases were 23 (27%), 3 (11%) and 0 in the 3 groups respectively at month 3. The above numbers were 44 (52%), 8 (30%) and 0 respectively at month 6.The numbers were 69(82%), 13 (48%) and 1 (13%) at month 12. The numbers were 78 (93%), 19 (70%), 3 (38%) at month 24. The numbers were 82(98%), 20(74%) and 4(50%) at month 36. Thirteen patients were treated with adenosine-triphosphate (ATP) stress echocardiography examiantion, 5 patients were evaluated by coronary angiography,and 4 patients were tested by 64-slice CT coronary reconstruction. Part of the patients were found to have coronary stenosis or occlusion. Conclusion Patients of Kawasaki's disease often have concurrent coronary artery lesions. Patients with mild dilatation of the coronary artery are the most commonly seen and have the best prognosis. On the contrast, patients with giant coronary aneurysm are the lest common situation and is the worst in prognosis. Part of them will develop coronary artery stenosis or occlusion in late stage which may lead to ischemic heart disease. We should stress on close follow-up of patients with Kawasaki's disease complicated with coronary artery lesion. Appropriate and timely treatment will increase their clinical outcomes.