儿童川崎病巨大冠状动脉瘤并血栓形成的临床特征及治疗

Clinical characteristics and therapy of Kawasaki disease with giant coronary artery and thrombosis

目的总结川崎病（KD）冠状动脉瘤（CAA）血栓形成患儿的临床特点，分析安全有效的溶栓治疗方法及其预后。方法回顾性分析华中科技大学同济医学院附属协和医院儿科2006年1月至2016年12月收治的210例KD患儿的临床、治疗及随访资料，分析CAA并血栓形成患儿的临床症状和辅助检查结果。超声监测CAA的特征。KD并血栓形成患儿均接受静脉给予尿激酶、肝素和口服华法林溶栓治疗和抗血小板治疗。通过测量溶解血栓的能力来评价抗血栓治疗的效果。结果210例KD患儿中14例患儿为巨大CAA并血栓形成。这14例患儿中，CAA直径最大可达18．5mm，平均12．6mm。CAA并血栓形成患儿不仅血液检查结果无异常，而且也无典型的KD症状和急性心肌梗死。血栓多发生于巨大动脉瘤处，2例患儿为多发血栓。经溶栓治疗，14例患儿中12例成功溶栓，2例患儿血栓机化并出现冠状动脉狭窄。结论KD患儿临床症状或实验室检查均不能准确预测CAA并血栓形成。KD患儿冠状动脉血栓易形成于巨大CAA处。随访有利于发现血栓。早期、足量的静脉溶栓治疗能有效地溶解血栓，避免病情恶化。

Objective To summarize the clinical characteristics of children with coronary artery aneurysms （CAA） and thrombosis in Kawasaki disease （KD） ,in order to explore the safe and effective thrombolytic therapy and its prognosis. Methods The clinic, treatment and follow - up data of 210 patients with KD between January 2006 and December 2016 were retrospectively reviewed in the Department of Pediatrics, Union Hospital ,Tongji Medical College, Huazhong University of Science and Technology. The clinic signs and laboratory data for CAA with thrombosis were analyzed. The characteristics of CAA were monitored by ultrasound. All KD patients with thrombus received intravenous antithrombotic therapy,including urokinase, heparin, and oral Warfarin, and anti - platelet treatment. The effectiveness of antithrombotic treatment was evaluated by measuring the ability to dissolve the thrombus. Results Fourteen cases in 210 patients with KD developed CAA, and had associated thrombosis. In these 14 patients, the largest diameter of CAA was 18.5 ram,and the average value was 12.6 mm. There was no special blood analysis in CAA with thrombus. Moreover, typical KD symptoms and acute myocardial infarction were not found in CAA with thrombosis. Thrombus occurred in giant aneurysms, and 2 patients had multiple thrombosis. After thrombolytic therapy, 12 cases in the 14 patients had suc- cessful thrombolysis ,2 patients had thrombus organization and coronary artery stenosis. Conclusions Neither clinical features nor laboratory data could reliably predict CAA associated thrombosis. Thrombus was easily formed in giant CAA. Frequent and periodly follow - up are important to detect thrombosis in KD patients with giant coronary artery. Therapy with adequate intravenous antithrombotic therapy and anti - platelet treatment earlier can effectively dissolve thrombus in KD patients,and avoid deterioration.