川崎病致心脏炎的临床观察

A clinical observation of carditis secondary to Kawasaki disease

目的 :探讨川崎病 (KD)所致心脏炎的发生情况及预后。方法 :对 182例KD患儿的临床资料进行回顾性分析 ,统计急性期心肌酶谱 (CK -MB)、心肌肌钙蛋白I(cTnI)、Holter及十二导联心电图 (ECG)、高频心电图 (HFECG)、超声心动图(UCG)异常的情况 ,临床表现 ,治疗及随访结果。结果 :急性期约 35 %的KD患儿伴有CK -MB、cTnI、Holter、ECG、HFECG及UCG的异常 ,除 2例有心功能不全外 ,其余无典型的心脏炎的表现 ,在≤ 10d内静脉滴注丙种球蛋白 (IVIG)的占 90 .6 6 % ,经1～ 9月的随访 ,血清CK -MB及cTnI,Holter、HEFCG及ECG均正常或好转。瓣膜口反流、左室动度减低、房室扩大及心包积液在 3～ 10周内逐渐消失。未发现遗留瓣膜损害、心脏扩大、缩窄性心包炎及严重心律紊乱等。结论 :本研究表明约 35 %的KD患儿急性期存在轻型—过性心肌、心内膜和 /或心包炎症 ,若早期诊断及治疗 ,预后良好。

Objective:To investigate the incidence rate of carditis secondary to Kawasaki disease(KD)and its prognosis.Methods:Clinical data including serum myocardial enzymes such as CK-MB and cTnI,Holter and 12-lead and high frequency electrocardiograms and echocardiography test results,clinical manifestation,therapeutic methods and prognosis were analyzed retrospectively in 182 patients with KD.Results:About 35%patients had abnormal CK-MB,cTnI,ECG or UCG in acute phase,but they had no typical carditis clinical manifestation besides 2 cases with heart failure.90.66% cases were given intravenous immune globulin(IVIG)within ten days from the onset and within one to nine months of follow-up,CK-MB,cTnI,ECG or UCG had improved or returned to normal.Valvular inadequacy,hypokinetic left ventricle,ventricle amplification and pericardial effusion disappeared gradually in three to ten weeks,.Valvular lesion,heart amplification,constrictive pericarditis and serious arrhythmia were not found.Conclusion:This study showea about 35% patients with KD might develop low-grade transient myocarditis,pericarditis or endocarditis.An early diagnosis and therapy could lead for the patients to have good course and no sequelae.