川崎病合并冠状动脉瘤的超声心动图研究

Echocardiographic study of kawasaki disease with coronary artery aneurysms

目的探讨川崎病合并冠状动脉瘤(CAA)的并发症及超声心动图在其诊断、随访中的价值。方法回顾性分析超声心动图定期随访的38例川崎病合并CAA患者的临床资料及并发症。结果 38例患者共检出79处CAA。其中17例24处(30%)瘤腔内并发血栓;5例(13%)发生冠脉狭窄,1例因侧支循环形成无明显症状;5例(13%)发生心肌梗死,4例死亡;2例(5%)因巨大CAA破裂猝死;7例(18%)CAA瘤壁钙化。本组共7例死亡,占18%,死亡时间均为90年代初,3例因急性期为不完全川崎病未识别故而未做系统治疗。结论川崎病合并CAA的并发症主要包括血栓形成、冠脉狭窄、心肌梗死、巨大CAA破裂及心源性猝死等。超声心动图对其诊治及预后评估有重要价值。

Objective To explore the complications of Kawasaki disease（KD）with coronary artery aneurysms（CAA）and the value of echocardiography in its diagnosis and follow-up.Methods The clinical data and complications of 38 cases of KD with CAA who were followed-up regularly using echocardiography were retrospectively analyzed.Fifteen cases were confirmed by coronary angiography,2 cases were confirmed by EBCT and 3 cases were confirmed by autopsy.Results Of 38 cases,a total of79 CAAs were detected.Seventeen cases（24 CAAs,30%）were complicated with thrombus.Coronary stenosis developed in 5 cases,1 case of them who had developed collateral circulation had no symptoms.Myocardium infarction occurred in 5 cases,4 cases of them died.Sudden death occurred in 2 cases due to rupture of giant CAA（5%）.Calcification of the CAA wall developed in 7 cases（18%）There were total 7 deaths in this group.All the deaths occurred in the early 1990 s,3 cases of them didn’t receive regular therapy due to unrecognized incomplete KD in acute stage.Conclusion The main complications of KD with CAA include thrombus,coronary artery stenosis,myocardium infarction,rupture of giant CAA and sudden cardiac death.Deaths occurred mainly in patients without formal anticoagulant therapy in the early years.Echocardiography can provide reliable information for diagnosis of KD and assessing its prognosis.