川崎病心肌损伤在疾病各期及随访管理中的观察

Observation on the myocardiac lesion in every stage of Kawasaki disease

目的观察川崎病患儿在发病各期的心肌损伤情况,特别关注随访患儿情况。方法收集住院及随访患儿共72例,其中伴心肌损伤32例,无心肌损伤40例。分析各期患儿心肌损伤发生、发展及恢复、演变结果。结果①伴心肌损伤患儿随访彩色超声示:左心室轻、中度扩大13例;左房扩大2例;EF下降2例;心包积液2例;二尖瓣反流1例。②6例在亚急性期和慢性期出现心肌酶升高。③本组患儿的心电图改变以I°AVB为主(14例)。④早期炎性指标血白细胞(WBC)、C-反应蛋白(CRP)可作为关注心肌损伤的重要参考指标,在其达到一定的高度(WBC≥20×109/L,CRP≥80)时,应警惕川崎病并发心肌损伤的可能。⑤冠状动脉病变与心肌损伤密切相关。⑥心肌损伤在恢复期和慢性期亦有发生,发生率为37.5%。结论所有川崎病患儿在后期随访中应定期复查超声心动图、心电图及心肌酶检查,特别是急性期炎性指标高和(或)冠脉病变的患儿。

Objective To study the incidence of myocardiac lesion in every stage of Kawasaki disease（KD）, especially the follow-up period in the out patient department （OPD）. Methods 72 cases of KD children from Beijing Children＇s Hospital were enrolled and studied, in whom myocardiac lesion was found in 32 cases. Results ①The results of Doppler ultrasound showed mild to moderate dilation of left ventricle （13 eases）, left atrial dilation （two eases）, atrial effusion （two cases） and mitral regurgitation （one ease） in the patients with myocardiac lesion. Six children had increased creacting kinase in subacute and chronic stage. The changes of ECG mainly preseuted with I ° atrioventricular block （AVB） in 14 cases; ②Early inflammatory parameters of WBC and CRP may indicate myocardiac lesion, especially when WBC ≥20×10^9/L and CRP≥ 80mg/L; ③Coronary artery lesions were found to be closely related to myocardiac lesion; ④ New myocardiae lesions may occur after the acute phase with an incidence of 37.5%. Conclusions UCG,ECG and creatine kinase need to be rechecked during the later follow-up of the effective assessment of myocardial lesion in KD children, expecially for whom with high inflammatory index and/or coronany artry dieeases.