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

Assessment value of adenosine triphosphate stress echocardiography and coronary angiography in long-term follow-up of patients with Kawasaki disease

目的探讨三磷酸腺苷(adenosine triphosphate,ATP)负荷超声心动图及冠状动脉造影(coronary angiography,CAG)在川崎病(Kawasaki disease,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。

Objectives To discuss the application value of adenosine triphosphate （ATP） stress echocardiography and coronary angiography （CAG） technique in long-term follow-up of coronary artery lesions in Kawasaki disease （KD）. Methods Totally 156 children diagnosed with Kawasaki disease were performed ATP stress eehocardiography in their recovery period, of who, 15 patients were also performed selective CAG. Follow-up duration was from 6 months to 10 years after the acute phase. Patients were divided into coronary artery aneurysms group, coronary artery dilatation group and normal coronary arteries group by the extent of coronary lesions. Results ATP stress echocardiography results showed each group had varying degrees of reduced coronary flow reserve and （or） ventricular wall motion abnormalities in recovery period. Incidence rates of them in coronary artery aneurysms group and coronary artery dilatation group were signifleantly higher than that in normal coronary arteries group [75.00% （30/40） vs. 44.29% （31/70） vs. 21.74% （10/46） ,P〉0.01 ]. Accordance rate of stress echocardiography and coronary angiography examination reached 93.33% （Kappa=0.04,P=0.70）. Conclusions CAG can demonstrate coronary artery clearly, but cannot accurately show coronary hemodynamics or coronary microcirculation. ATP stress echocardiography can safely and reliably evaluate coronary hemodynamics. Thus, it can be used to evaluate long-term follow-up of coronary artery lesions and drugs curative effects in children with KD as a compliment to CAG.