摘要
OBJECTIVE: To investigate the course of coronary artery lesions caused by Kawasaki disease, and the value of coronary angiography (CAG) and two-dimensional echocardiography (2-D Echo) in the evaluation and follow-up of coronary artery lesions. METHODS: Eighty seven patients with coronary artery lesions caused by Kawasaki disease from 1979 to 1997 were retrospectively analyzed. One hundred and sixty-seven CAGs were performed in 87 patients during follow-up. CAG was repeated every 1-3 years in each patient until complete regression was confirmed. 2-D Echo was performed before CAG each time. The longest period of follow-up was 16 years and 6 months. Patients were treated with aspirin or aspirin and warfarin. RESULTS: During follow-up, the coronary artery lesions regressed in 48/87 (55%) patients, however, they developed into severe coronary artery lesions in 6/87 (7%) patients in whom coronary artery bypass surgery was performed. The coronary artery aneurysm regressed in some patients, while stenotic lesions remained or developed. The ratio of coronary artery stenotic lesions to aneurysms increased progressively. This study showed that Echo diagnosis of coronary artery lesions has 'false positives' and 'false negatives'. Only 76% of coronary aneurysms and 18% of stenotic lesions could be found by 2-D Echo. No stenotic lesion could be found in distal segments of the coronary artery. CONCLUSIONS: Long term follow up revealed spontaneous regression occurred in 55% of patients and development into severe coronary artery stenosis in 7%. It is necessary to perform long-term follow-up in patients with coronary artery lesions caused by Kawasaki disease. 2-D Echo can not completely replace CAG during follow-up of coronary artery lesions caused by Kawasaki disease.
目的 探讨川崎病后冠状动脉病变及转归 ,以及二维超声心动图和选择性冠状动脉造影在冠状动脉病变判断和长期随访中的作用。方法 1979- 1997年因川崎病在治疗和随访中发现有冠状动脉病变的 87例 ,最长随访时间为 16年 6月。随访时给予阿斯匹林或阿斯匹林加华法令口服。每个病人每隔 1- 3年进行选择性冠状动脉及左室造影检查 ,直至正常。总共行选择性冠状动脉及左室造影 16 7次 ,每次造影前均行二维超声心动图检查。结果 造影发现 4 8/87(5 5 % )病儿的冠状动脉病变在随访过程中消失 ,6 /87(7% )病儿出现严重的冠状动脉病变导致明显的心肌缺血或心肌梗塞而需行冠状动脉搭桥手术。随着随访时间的延长 ,狭窄或血栓性冠状动脉病变的比例逐渐增高 ,冠状动脉瘤的比例逐渐降低。造影与二维超声心动图对照研究发现二维超声心动图检查存在假阳性和假阴性。二维超声心动图检查冠状动脉瘤的发现率为 76 % ,狭窄或血栓性病变的发现率为 18% ,不能发现远端冠状动脉的狭窄或血栓性病变。结论 长期随访发现 5 5 %病儿的冠状动脉病变可以恢复正常 ,7%的病儿可发展成严重的冠状动脉病变。川崎病病儿均需长期随访 ,当出现严重冠状动脉病变时需及时处理。
