川崎病合并冠状动脉病变患儿117例冠状动脉造影结果分析

Analysis of coronary angiographic findings in 117 children with Kawasaki disease and coronary artery lesion

目的分析川崎病(KD)患儿冠状动脉造影(CAG)资料中冠状动脉病变(CAL)的特点, 探讨CAG在KD合并CAL患儿诊治中的重要性。方法回顾性分析2013年1月至2022年8月于上海交通大学医学院附属上海儿童医学中心行CAG检查的KD合并CAL患儿的临床资料、心电图、心脏超声及CAG检查时间及结果, 分析CAL病变的分布、病变类型、严重程度及预后。结果共117例KD合并CAL患儿被纳入分析, 患儿KD发病年龄为2个月至12.8岁, 造影年龄为8个月至18.1岁。共234支冠状动脉发生病变, 其中, 右冠状动脉(RCA)96支(41.1%), 左冠状动脉前降支(LAD)78支(33.3%), 左冠状动脉主干44支(18.8%), 左回旋支16支(6.8%)。单侧冠状动脉受累43例患儿, 占36.8%, 以LAD受累最显著;双侧冠状动脉受累74例, 占63.2%, 以LAD与RCA同时受累占比最多。从冠状动脉受累的严重程度来看, RCA与LAD大型冠状动脉瘤与严重冠状动脉狭窄的发生率最高;管腔内病变在小型、中型、大型冠状动脉瘤、狭窄或闭塞部位分别检出10例(13.6%)、20例(24.3%)、55例(45.8%)、37例(67.3%), 病变越严重的部位, 发生管腔内病变的概率也越高。CAG显示冠状动脉狭窄或闭塞共55例, 重度狭窄或闭塞病例均伴不同程度和类型的侧支循环形成。结论 KD合并CAL患儿的CAL复杂且程度不一, 临床症状、常规心电图和心脏超声虽然可提示部分患儿存在严重的CAL, 但对于CAL类型(尤其是狭窄)、程度及范围和冠状动脉外病变检出存在明显局限, CAG对了解KD合并CAL患儿的血管病变情况和指导治疗有重要价值。

Objective To analyze the coronary angiographic(CAG)characteristics of coronary artery lesion(CAL)in children with Kawasaki disease(KD),and to clarify the necessity of CAG in the diagnosis and treatment of KD combined with CAL in children.Methods It was a retrospective study to analyze the clinical data,electrocardiogram,echocardiography,time and findings of CAG in children with KD and CAL who underwent CAG in Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2013 to August 2022.The distribution,type,severity,and prognosis of CAL were analyzed.Results A total of 117 children with KD and CAL were included in the analysis.The onset age of KD was from 2 months to 12.8 years old,and the age of performing CAG was from 8 months to 18.1 years old.A total of 234 coronary artery lesions were detected in 117 cases.Among them,CAL in the right coronary artery(RCA),left anterior descending branch(LAD),left main coronary artery and left circumflex artery were detected in 96 branches(41.1%),78 branches(33.3%),44 branches(18.8%),and 16 branches(6.8%),respectively.Unilateral coronary artery involvement was detected in 43 cases(36.8%),of which LAD was the dominant;while bilateral involvement was detected in 74 cases(63.2%),among which,LAD and RCA were the most involved arteries.Stratified by the degree of coronary involvement,large coronary aneurysms and severe coronary stenosis were most frequently occurred in the RCA and LAD.In contrast,10 cases(13.6%),20 cases(24.3%),55 cases(45.8%)and 37 cases(67.3%)of intraluminal lesions were found in small,medium and large coronary aneurysms,and stenosis or occlusion,respectively.The incidence of intraluminal lesions tended to be higher in the site of severe lesions.CAG showed stenosis or occlusion in a total of 55 cases,and collateral circulation at varying degrees was found in cases of severe stenosis or occlusion.Conclusions CAL in children with KD are complex and varied.Although clinical symptoms,routine electrocardiogram and cardiac ultrasound may indicate severe CAL.Their applications are limited by the diagnosis of the type(especially stenosis),degree,and extent of CAL,as well as the detection of extracoronary lesions.CAG is of great significance to identify vascular lesions and guide clinical management of KD combined with CAL in children.