川崎病冠状动脉病变的心电图改变

川崎病可累及全身各个系统 ,以心血管系统受累最为广泛和严重 ,主要为冠状动脉扩张和冠状动脉瘤。川崎病冠状动脉病变是临床防治的核心。修正的 Asai评分法是较完善的预测方法 ,但项目繁多 ,应用欠方便。本文对川崎病冠状动脉病变的心电图改变进行了分析 ,探讨预测川崎病冠状动脉病变的心电图指标。1　临床资料1 998年 8月～ 1 999年 8月间重庆医科大学儿童医院收治住院的川崎病患儿 1 2 0例 ,临床表现均符合《实用儿科学》(人民卫生出版社第 6版 ,1 998年 )川崎病的诊断标准。根据冠状动脉内径≥ 4mm诊断为冠状动脉扩张 ( CAD) ,冠状动脉…     

原因未明的传染病

川崎病急性期冠状动脉病变的多普勒超声检测及其临床意义——邱宝明等(广东深圳市儿童医院518026)；《临床超声医学杂志》，2003，5(5)：263—265[目的：探讨川崎病急性期的多普勒超声检测及其临床意义。方法：回顾分析142例川崎病急性期的多普勒超声表现，并与     

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.     

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。     

非高密度脂蛋白胆固醇与载脂蛋白A-I比值与冠状动脉慢血流相关性分析

目的 探讨非高密度脂蛋白胆固醇与载脂蛋白A-I比值对冠状动脉慢血流的影响.方法 选取2019年8月至2021年8月我院行冠状动脉造影(coronary angiography,CAG)检查的217例拟诊冠状动脉粥样硬化性心脏病(冠心病,coronary atherosclerotic heart disease,CHD...     

女性冠心病患者冠状动脉造影结果与危险因素关系探讨

冠状动脉造影(coronary angiography,CAG)在诊断冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)时比心电图、活动平板试验的诊断正确率高,尤其对不典型症状较多的女性其意义更大.     

丹参酮ⅡA对川崎病并发冠状动脉损害患儿基质金属

目的　检测不同的治疗方案下川崎病（　Kawasaki　disease,　KD　）患儿治疗前后基质金属蛋白酶9　（matrix　metalloproteinase-9,　MMP-9）及组织型基质金属蛋白酶抑制剂1　（　tissue　inhibitor　of　metalloproteinase-1,　TIMP-1）表达的动态变化，分析丹参酮ⅡA（TanⅡA）对上述指标的影响以及对川崎病并发冠状动脉损害（coronary　artery　1esion,　CAL）的保护作用。方法　将2010　年4　月至2012　年9　月在南华大学附属第二医院住院治疗的川崎病患儿48例，包括无冠状动脉损害28例，有冠状动脉损害20例。随机分为TanⅡA加常规治疗组和常规治疗组，各组24例（无冠状动脉损害14例，有冠状动脉损害10例），并以健康体检儿童作为对照组。分别采用酶联免疫吸附法（ELISA）检测治疗前后患儿血清MMP-9、TIMP-1变化表达变化。实时荧光定量PCR（qRT-PCR）检测治疗前后患儿外周血单个核细胞（peripheral　blood　mononuclear　cells,　PBMC）MMP-9、TIMP-1　mRNA表达水平。结果　川崎病患儿治疗前MMP-9、TIMP-1　mRNA和蛋白表达均较正常对照组显著升高，且有冠状动脉损害的川崎病患儿血清MMP-9、TIMP-1、MMP-9/TIMP-1比值明显高于无冠状动脉损害（no　coronary　artery　1esion,　NCAL）川崎病患儿（P<0.05）；治疗5～7　天后　MMP-9、TIMP-1　mRNA和蛋白表达显著降低（P<0.05），其中TanⅡA加常规治疗组较常规治疗组MMP-9、TIMP-1　mRNA和蛋白表达下降更明显（P<0.05），同时，在有冠状动脉损害的川崎病患儿中，　TanⅡA加常规治疗后，与常规治疗相比，其血清MMP-9、TIMP-1也明显降低（P<0.05）。结论　TanⅡA可以一定程度抑制川崎病患者MMP-9、TIMP-1　mRNA和蛋白表达，从而减轻血管炎性损伤，减少川崎病并发冠状动脉损害。     

川崎病的冠状动脉损害研究概况

川崎病的冠状动脉损害研究概况广东工学院医院李洁综述武汉冶金高等医学专科学校张天民审校川崎病自１９６７年首次报告后，日本已有１０万例以上，全世界都有病例报道。川崎病患者中２０％～４０％有冠状动脉（管称冠脉）损害，可致心肌梗塞、心衰、猝死［１］，是川崎病...     

远端桡动脉入路在冠状动脉造影及介入中的研究进展

远端桡动脉入路(distal transradial access,dTRA)是对冠心病患者行冠状动脉造影(coronary angiography,CAG)及经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的一种新的手术途径,近年来,国内外心血管病医生都在尝试这一新...     

冠状动脉血流储备分数研究进展

<正>目前,全球范围内冠状动脉心脏病(coronary artery disease,CAD)发病率和病死率居高不下[1]。一直以来,冠状动脉造影(coronary angiography,CAG)被认为是诊断CAD的"金标准"。然而,随着对冠状动脉血流动力学和病理生理学研究不断深入,发现CAG在评价冠状动脉狭窄病变解剖特征和生理功能等方面也存在不足。血流储备分数(fractional     

Advantages of multislice spiral computed tomography for evaluation of serious coronary complications after Kawasaki disease

OBJECTIVES: Novel multislice spiral computed tomography (MSCT) findings were identified in patients after Kawasaki disease that could not be detected by coronary angiography (CAG). METHODS: Eighteen patients had suffered from serious coronary arterial lesions after Kawasaki disease (mean age 21.7 years, range 13-34 years). Seventeen patients had stenotic lesions, and all of them had coronary aneurysms. MSCT was performed using a Siemens SOMATOM Volume Zoom (4-detector row) or a Toshiba Aquillion 16 (16-detector row). Findings of coronary calcification, stenotic lesion, and intimal hypertrophy in all coronary arteries were compared to those of CAG. RESULTS: Eleven of the 18 patients (61%) had novel findings detected by MSCT. Coronary calcifications were found in 11 of the 18 patients (61%). Five patients had concentric calcified aneurysms, four had eccentric calcified aneurysms, and two had mixed calcified aneurysms. Coronary stenotic lesions were present in 6 of the 18 patients (33%) with calcified aneurysms. Two patients had intimal hypertrophy (11%). One patient had intimal hypertrophy along the left main trunk with a giant calcified aneurysm along the left anterior descending artery. Two patients had severe stenoses just distal to giant calcified aneurysms that were regarded as false positive findings, and were identified as mild stenoses by CAG. CONCLUSIONS: MSCT offers advantages over CAG in the evaluation of calcified aneurysms and intimal hypertrophy, and is a potential diagnostic modality for coronary intervention in patients after Kawasaki disease.     

An adult case of kawasaki disease with multiplex coronary aneurysms and0 myocardial infarction: The role of transesophageal echocardiography

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute inflammatory disease that primarily affects infants and young children. in spite of proper therapy, coronary aneurysms develop in 10 to 25% of cases. Adult diagnosis of coronary aneurysm, presumably caused by Kawasaki disease, is rare. A 37-year-old male patient with previous inferior wall myocardial infarction (MI) was admitted with an acute anterior wall MI. Coronary angiography, performed 2 weeks after successful thrombolytic therapy, showed right coronary artery occlusion and multiplex (left main, left anterior descending, left circumflex, right coronary artery) giant coronary aneurysms. Transthoracic echocardiography was unable to detect the aneurysms. Transesophageal echocardiography (TEE) visualized a large left main coronary aneurysm with an occlusive thrombus and measured low flow velocity (0.2 m/s) in the proximal left anterior descending artery. At 4 weeks control, TEE showed marked regression of the thrombus, and it was not detectable after 6 months of oral anticoagulation with acenocumarol (International Normalized Ratio: 3-3.5) and standard postinfarction therapy. After 2 years of follow-up, the patient has no symptoms, and myocardial ischemia could not be provoked by stress tests [treadmill, dipyridamole single-photon emission computed tomography (SPECT)]. We conclude that, for diagnosis and follow-up of adult Kawasaki disease, transesophageal echocardiography is indicated. The importance and efficacy of long-term anticoagulant treatment should be emphasized in this disease.     

Congenital giant aneurysm of the left coronary artery

We report an unusual case of congenital giant coronary aneurysm. A 23 year-old male with a history of acute myocardial infarction presented an abnormal shadow in the left cardiac border on routine X-ray. Electrocardiogram and physical examination were normal without any clinical signs of inflammation, but computed tomography (CT) scan and cardiac magnetic resonance imaging (MRI) revealed a giant (>50mm) coronary aneurysm. Coronary artery bypass grafting (CABG) with coronary artery aneurysm (CAA) resection resolved the CAA. Coronary artery aneurysms are entities of localised dilation and can be common events in chronic infectious disease as a result of the systemic inflammatory state; however, giant coronary aneurysms (measuring more than 50mm) are rare. This is especially true where the pathological aetiology was not clearly defined or was believed to be of congenital origin. To date only a few published case reports exist for this type of pathological entity.     

Stent implantation for coronary aneurysm with edge stenosis: angiographic and intravascular analysis

The incidence of coronary artery aneurysms is about 1 to 2%, with clinical course dependent on the size of the aneurysm. A case of moderate-size aneurysm in the proximal left anterior descending coronary artery with stenosis at both edges is presented. This was interrogated with intravascular ultrasound (IVUS), and based on the patient's presentation, a single stent, size-matched 1:1 to the proximal reference, was placed across the aneurysm and both lesions. Post-implantation IVUS demonstrated residual stenosis and minimal change in the neck size of the aneurysm. At 4 months, there was no thrombosis or in-stent restenosis, and the aneurysm was almost completely resolved.     

血管内超声诊断冠状动脉临界病变的临床研究

目的：探讨血管内超声（IVUS）诊断左冠脉前降支及左主干冠状动脉临界病变的应用价值。方法：以60例冠状动脉造影（CAG）诊断的冠状动脉临界病变（包括20例左主干病例,前降支近段20例,前降支中段20例）为标准,分析血管内超声（IVUS）检查冠状动脉临界病变的价值。结果：与CAG检查比较,IVUS检查的冠状动脉平均直径狭窄率均显著升高[左主干：（65．31±7．81）％比（75．28±8．89）％,前降支近段：（66．67±8．79）％比（78．89±7．88）％,前降支中段：（71．55±6．83）％比（75．31±7．81）％,P均〈0．01]。CAG和IVUS检查在斑块钙化及斑块破裂的检出率方面无显著差异（P〉0．05）。结论：CAG不同程度地低估了冠状动脉狭窄,尤其是前降支近段,IVUS可对CAG作有效的补充,并且提高不稳定斑块的检出率,弥补了CAG的不足。     

Giant left main coronary artery aneurysm in association with severe atherosclerotic coronary disease

Aneurysms of the coronary arteries occur in 1.5–4.9% of coronary angiograms. Only a few cases of a giant aneurysm of the left main coronary artery in conjunction with severe atherosclerotic coronary disease have been reported. This report details the exceptional case of a 72-year-old patient with a giant “true saccular” aneurysm branched on the left main coronary artery. The development of an aneurysmal dilatation in conjunction with progression of coronary arteriosclerosis, observed from two different angiographic studies at an interval of 25 years, is very illustrative for evolutive atherosclerotic heart disease. This finding may support the hypothesis that atherosclerosis may be the common etiology for coronary aneurysmal dilatation. Cathet. Cardiovasc. Diagn. 42:54–57, 1997. © 1997 Wiley-Liss, Inc.     

冠心病伴束支传导阻滞患者冠状动脉病变特点研究

目的 :探讨冠心病伴束支传导阻滞患者冠状动脉血管病变特点。方法 :回顾性分析冠心病伴束支传导阻滞患者 (束支阻滞组 ,39例 )及无束支阻滞的冠心病患者 (对照组 ,35 1例 )心电图束支阻滞有无与冠状动脉病变的对应关系。结果 :与对照组比较 ,束支阻滞组左主干、左回旋支 (LCX)及三支血管 [左前降支 (LAD)、LCX、右冠状动脉 (RCA)同时存在病变 ]发生病变比率增加 (P <0 .0 1,P <0 .0 5 ,P <0 .0 5 )。右束支传导阻滞(RBBB)者LAD及RCA发病率高 ,RBBB并发左前分支阻滞 (LAFB)者三支血管病变发生率增高 ,左束支传导阻滞 (LBBB)者LAD、LCX病变发生率高 ,LAFB者LAD病变发生率高 ,房室传导阻滞伴束支阻滞患者多为三支血管病变。结论 :冠心病伴束支阻滞预示冠状动脉病变广泛而严重 ,LBBB提示冠状动脉血管病变以左冠状动脉为主 ,RBBB提示冠状动脉血管病变多累及RCA及LAD ,如存在 2种以上阻滞 ,特别是并发有左前分支或房室阻滞时 ,多提示存在三支血管病变及左主干病变     

三磷酸腺苷负荷超声心动图和冠状动脉造影在川崎病远期随访中的价值

目的探讨三磷酸腺苷（adenosinetriphosphate，ATP）负荷超声心动图及冠状动脉造影（coronaryangiography，CAG）在川崎病（Kawasakidisease，KD）冠状动脉损害远期随访中的应用价值。方法对临床确诊的156例KD患儿于恢复期行ATP负荷超声心动图检查，其中15例患儿同时进行CAG。随访时间为自急性期后6个月至10年，按急性期冠状动脉损害程度分为冠状动脉瘤组、冠状动脉扩张组及冠状动脉正常组。结果恢复期ATP负荷超声检查结果显示，3组均有部分患儿存在不同程度的冠状动脉血流储备下降和（或）出现节段性室壁运动异常，其在冠状动脉瘤组和冠状动脉扩张组的发生率高于冠状动脉正常组，差异有统计学意义[75．00％（30／40）vs.44．29％（31／70）vs．21．74％（10／46），P〉0．01]。15例同时进行CAG与负荷超声检查的患者结果显示，两种检查方法的符合率为93．33％（Kappa=0．04，P=0．70）。结论CAG能较清楚地显示冠状动脉形态，但不能准确地提供冠状动脉血流动力学信息及冠状动脉微循环的情况；ATP负荷超声心动图检查能安全、可靠地评估冠状动脉血流动力学，补充冠状动脉造影的不足，可用于KD患儿冠状动脉损害的长期追踪随访以及药物疗效的判断。     

Surgical treatment of a large left-main coronary artery aneurysm

Coronary artery aneurysms are a rare condition with left-main trunk aneurysms occurring in only about 0.1 % of the population. We report on a giant left-main coronary artery aneurysm in a young male status post two previous open-heart operations. The aneurysm was successfully treated by patch occlusion of the ostial orifice and coronary revascularization of the left anterior descending and circumflex arteries.     

Degenerative aortic valvular stenosis, coronary atherosclerosis, and coronary artery aneurysms: different anatomical manifestations of the same disease

We report a rare combination of valvular aortic stenosis, coronary atherosclerosis and numerous coronary artery aneurysms. A 80 year-old man with previously diagnosed aortic valvular stenosis was admitted to our department for coronary angiography before planned aortic valve replacement. Coronary angiography, apart from critical stenosis of proximal part of left anterior descendent branch of left coronary artery, revealed several large coronary artery aneurysms. We discuss the potential mechanisms responsible for coronary aneurysm formation.