108例川崎病并冠状动脉损害的临床观察与随访

Clinical observation and follow-up of 108 cases of Kawasaki disease with lesion of coronary artery

目的：为临床诊断和治疗川崎病（Kawasaki disease，KD）并发冠状动脉损害提供参考。方法：回顾性分析186例KD患儿的临床资料，并对不完全KD的特点进行分析。结果：186例KD经1～2次二维超声心动图检查发现冠状动脉损害108例，发生率58．1％，不完全KD更易并发冠状动脉损害。其中轻度冠状动脉扩张60例（55．6％），中度36例（33，3％），重度12例（11．1％）。108例病例经过1～3年的随访，轻度冠状动脉扩张者均在6个月内恢复正常，而中度、重度扩张者除3例巨瘤并发冠状动脉血栓形成、冠脉狭窄发生心肌梗死、心肌病外，余在6个月内均有改善，其中1年内消失30例，2年内消失8例，3年内消失7例；急性期未发现冠状动脉损害者随访1～2年均未发现异常。结论：不完全KD易并发冠状动脉病变且冠状动脉瘤预后较差，对可疑KD病例应尽早作二维超声心动图检查以提高对不完全KD的早期诊断及治疗。

Objective To provide a reference for diagnosing and treating Kawasaki disease （ KD ）. Methods We retrospectively analyzed the clinical data of 186 cases of final diagnosed Kawasaki disease and observed the characteristics of incomplete KD. Results There were 108 cases of KD with lesion of coronary artery in 186 cases through 2-dimensional echocardiography. The incidence rate was 58.1% ; it was easer to complicate with lesion of coronary artery in incomplete KD. Of them, slight coronary artery .eurysma was 60 cases （55.6%） , moderate coronary artery eurysma was 36 cases （ 33.3 % ） , and severe coronary artery eurysma was 12 cases （ 11.1% ）. After 1 to 3 year＇ s follow-up to all cases, the cases of slight coronary artery eurysma all recoverred in 6 months. The state of an illness in the cases of moderate and heavy coronary artery eurysma was improved in 6 months except 3 huge aneurysm combining coronary artery thrombosis and coronary artery stenosis developed heart infarction and cardiomyopathy. The 30 eases of coronary artery eurysma recovered in 1 year, 8 cases in 2 years, and 7 cases in 3 years. The patient that were not found with arterial coronary at the acute stage had no abnormality in 1 to 2 years after the treatment. Conclusion It is easier to complicate with lesion of coronary artery in incomplete KD and the prognosis of coronary aneurysm is worse. To improve early diagnose and treatment of incomplete KD, it is necessary to use 2-dimensional echocardiography to check the suspected cases.