川崎病合并冠状动脉损害的临床超声随访

Clinical follow-up of Kawasaki disease with coronary artery lesions by ultrasound

目的 探讨川崎病（Kawasaki disease,KD）合并冠状动脉损害患儿的临床预后.方法 回顾分析2002年1月至2011年12月收治的KD合并冠状动脉损害254例患儿的临床诊治与随访资料.结果 本组冠状动脉损害占KD患者总数的28％,其中冠状动脉扩张（CAD）216例,占KD的28.16％,冠状动脉瘤（CAA）38例,占4.2％.随访结果：随访冠状动脉扩张210例,其中有单侧（左或右冠状动脉）冠状动脉扩张99例（47.14％）随访3个月内恢复正常;21例（17.5％）6～12个月内恢复正常.双侧（左、右冠状动脉）冠状动脉扩张26例（11.26％）随访12～18个月恢复正常,59例（25.54％）随访18～36个月恢复正常,5例（近期）仍在随访中.随访冠状动脉瘤35例,冠状动脉瘤内径＜6 mm 28例12～36个月恢复正常,冠状动脉内径＞8 mm的巨大动脉瘤7例,2例随访12～24个月尚未恢复,3例随访24～36个月双侧均有回缩或单侧恢复后留有不同程度的冠状动脉扩张;2例分别随访6年、8年仍存单侧冠状动脉瘤,另侧冠状动脉扩张.结论 轻、中度冠状动脉扩张预后较好,冠状动脉瘤的恢复相对冠状动脉扩张时间长;巨大动脉瘤特别伴有心肌病变,以及多脏器损害预后较差.

Objectives To investigate the clinical prognosis of Kawasaki disease （KD） in children with coronary artery lesions.Methods The data of clinical diagnosis and follow-up of 254 children with KD complicated with coronary artery lesions from January 2002 to December 2011 were analyzed.Results In this group,coronary artery lesions accounted for KD cases was 28％,among which,coronary artery dilatation （CAD） was 28.16％ （216 cases） and coronary artery aneurysm （CAA） was 4.2％ （38 cases）.The follow-up results：210 cases with CAD,including 99 cases （47.14％） of unilateral （left or right coronary artery） CAD returned to normal in 3 months; 21 cases （17.5％） returned to normal within 6-12 months.Twenty-six cases （11.26％） of bilateral （left and right coronary artery） CAD returned to normal within 12-18 months; 59 cases （25.54％） returned to normal within 18-36 months; 5 cases （recent） were still in followup.Thirty-five cases were followed up for CAA.CAA diameter ＜6 mm in 28 cases were back to normal in 12-36 months.Of the 7 cases with giant CAA diameter ＞8 mm,2 cases has not yet recovered in 12-24 months,3 cases followed up for 24-36 months had unilateral or bilateral retraction recovery and still with CAD,2 cases followed up for 6 years and 8 years respectively still had single-sided CAA,and CAD on the other side.Conclusions Mild to moderate CAD is with good prognosis.Comparing with CAD,CAA needs more time to recover; giant aneurysm,especially associated with myocardial lesions,and muhiple organ damage have bad prognosis.