广州市儿童医院2001至2004年川崎病患儿冠状动脉损害的特点及随访

目的 探讨广州市儿童医院2001至2004年川崎病（KD）患儿冠状动脉损害的发生及恢复期变化特点。方法 采用彩色多普勒超声心动图检查广州市儿童医院收治的KD患儿，对伴冠状动脉损害者进行随访，KD 患儿恢复期接受三磷腺苷负荷超声心动图检查。按急性期冠状动脉扩张的程度，将KD患儿分为冠状动脉扩张组、中小型冠状动脉瘤组和巨大型冠状动脉瘤组，分别比较其发病及变化特点。结果 共纳入KD患儿356例，冠状动脉损害发生率为41.3％（147/356）；巨大型和中小型冠状动脉瘤组确诊前发热时间明显长于冠状动脉扩张组［(18.5±12.0) d、(12.9±8.2) d vs (7.4±3.6) d， P均<0.01］］。有119例（81.0％，119/147）冠状动脉损害患儿定期门诊随访。随访2年，超声心动图显示冠状动脉扩张组72例患儿冠状动脉全部恢复正常；中小型冠状动脉瘤组77.8%（28/36）患儿冠状动脉恢复正常；巨大型冠状动脉瘤组11例患儿无一例恢复正常。40例冠状动脉有损害的KD患儿恢复期三磷腺苷负荷超声心动图检查结果显示中小型和巨大型冠状动脉瘤组室壁运动异常、冠状动脉血流储备下降的发生率显著高于冠状动脉扩张组（P< 0.05）。结论 KD患儿急性期冠状动脉扩张损害为一过性；大部分中小型冠状动脉瘤改变可恢复；巨大型冠状动脉瘤造成的损害可长期存在。超声心动图和三磷腺苷负荷超声心动图对追踪观察KD冠状动脉损害的变化及心肌供血有重要帮助。

The morbidity of coronary artery lesions caused by Kawasaki disease in Guangzhou Children's Hospital and the four years follow-up

Objective To explore the onset characteristics of coronary artery lesions caused by Kawasaki disease and their changes in 2 years after onset. Methods A colour Doppler echocardiography was performed on 356 patients with Kawasaki disease in Guangzhou Children′s Hospital from January 2001 to December 2004. The ages of patients (242 boys, 114 girls) in acute stage were 1-123 months［（26.3±21.0）months］］. The patients were divided into three groups according to changes in coronary arteries: coronary arterial dilatation(n=72), small or medium coronary aneurysm(n=36) and giant coronary aneurysm group(n=11). The patients with coronary artery lesions were followed-up by echocardiography in 119 cases and ATP stress echocardiographyin in 48cases. The differences of febrile days before diagnosis and the changes in coronary artery were compared respectively among three groups . Results The coronary artery lesions were found in 147 patients（41.3%，147/356） by echocardiography, including 48 cases with coronary aneurysms (13.5%,48/356) and 99 cases with coronary arterial dilatation (27.8%,99/356) . The incidences of coronary artery lesions were 38.1%(40/105) in patients aged<1 y, 40.4%(67/166) in patients aged 1-3 y; 40.7%(22/54) in patients aged 3-5 y; 58.1%(18/31) in patients aged>5 y. The incidence of coronary artery lesions in patients aged>5 y was significantly higher than that in patients aged< 1 y (P<0.05). The febrile days before diagnosis in the giant coronary aneurysm group were more than that in medium or small coronary aneurysm group and the coronary arterial dilatation group［(18.4±12.0)days,(12.9±8.2)days,(7.4±3.6)days，P<0.01］］. By echocardiography, 69 of cases (69.7%,69/99) with coronary atery lesions were found in acute stage, 27 of cases (27.3%) in subacute stage (11-21 d from onset),3 of cases (3.0%) in convalescence (21-60 d from onset). 27 of cases (56.2%,27/48) with coronary arterial aneurysms lesions were found in acute stage, 15 of cases (31.2%) in subacute stage and 6 of cases (12.5%) in convalescence . 119 patients (81.0%,119/147) were followed-up. During two years follow-up, the coronary artery lesions were recovered in all patients in coronary arterial dilatation group and in 77.8%(28/36) patients of medium or small coronary aneurysm group. In giant coronary aneurysm group, the mild or moderate regressions were found in 8 of 11 patients; the aneurysms turned to dilatation in 3 cases; the right coronary artery stinosis was observed in 1 case, which was conformed by coronary angiography. 48 of 119 cases were given ATP stress echocardiography.The results revealed that in coronary arterial dilatation,small or medium coronary aneurysm and giant coronary aneurysm group，the incidences of wall motion abnormalities were 14.8％（4/27）,58.8％（10/17）and 75.0％（3/4）,respectively , and the rates of decreased coronary flow reserve were 22.2%（6/27）in patients with coronary arterial dilatation, 38.1%(8/21) in patients with coronary aneurysm . the rate of decreased coronary flow reserve in coronary aneurysm group was significantly higher than that in the group of coronary artery dilatation（P< 0.05）. Conclusions Most of coronary artery lesions caused by Kawasaki disease were transient.The giant coronary aneurysms may exist for longer time. Echocardiography is helpful for finding the coronary artery lesions and monitoring their changes.Stress echocardiography is useful for the follow-up of Kawasaki disease.