儿童川崎病合并冠状动脉病变的诊治进展

Progress in diagnosis and treatment of Kawasaki disease with coronary artery disease in children

皮肤黏膜淋巴结综合征即川崎病,自1967年日本医生首次报道以来,全世界60多个国家及地区陆续已有相关病例报告,近些年世界各国的发病率也陆续增加。川崎病病因和发病机制至今仍未明确,一般认为川崎病是一种以急性全身血管炎为主要表现的自限性疾病,主要影响中小型动脉,在婴儿和5岁以下儿童多发。目前认为川崎病最严重的并发症是冠状动脉病变,已取代风湿热成为发达国家儿童后天获得性心脏病的主要病因。随着现代医学诊疗技术的发展,大多数川崎病患儿能够及时准确诊断,再加上积极予以丙种球蛋白治疗,因此川崎病合并冠状动脉病变的发病率有所下降,但最终仍有2%~3%的患儿可能发生冠状动脉狭窄、扩张或闭塞,严重者可导致心肌梗死。因此,如何早期识别川崎病,并在川崎病合并冠脉病变时可以及时发现和干预,从而改善患儿生活质量、降低病死率,已成为川崎病诊疗策略中最值得关注并亟待解决的问题。本文就川崎病合并冠状动脉病变的诊断和治疗进行综述,为临床工作的儿科医生以及管理受川崎病影响儿童的社区全科医师在川崎病合并冠状动脉病变的诊断和治疗上提供一定的参考依据。

Kawasaki disease,or cutaneous mucocutaneous lymph node syndrome,has been reported in more than 60 countries and regions worldwide since it was first reported by doctors in Japan in 1967.Its incidence has been increasing in recent years in countries around the world.The etiology and pathogenesis of Kawasaki disease remain unclear.In general,we can assume that Kawasaki disease is a self-limiting disease with acute systemic vasculitis,mainly affecting small and medium-sized arteries,and it is prevalent in infants and children under 5 years of age.The most serious complication of Kawasaki disease is now coronary artery disease,which has replaced rheumatic fever as the main cause of acquired heart disease in children in developed countries.With the development of modern medical treatment technology,most children with Kawasaki disease can be diagnosed accurately in time.Coupled with active treatment with gammaglobulin,the incidence of Kawasaki disease combined with coronary artery lesions decreased,but eventually 2%-3%of children may still develop coronary artery stenosis,dilatation or occlusion,which can lead to myocardial infarction in severe cases.Therefore,identifying Kawasaki disease at an early stage,and detecting and intervening in Kawasaki disease combined with coronary artery lesions in time,to improve the quality of life of children and reduce the morbidity and mortality rate,has become the most noteworthy and urgent problem in the diagnosis and treatment strategy of Kawasaki disease.This article provides a review of the diagnosis and treatment of Kawasaki disease combined with coronary artery lesions to provide a reference point for pediatricians working in the clinic and for community general practitioners managing children affected by Kawasaki disease in the diagnosis and treatment of Kawasaki disease combined with coronary artery lesions.