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目的分析川崎病(KD)合并冠状动脉(以下简称冠脉)瘤患儿的临床特点。方法对首都医科大学附属北京儿童医院2000—2007年收治的63例超声心动图诊断为冠脉瘤的KD患儿临床资料、实验室检查、超声及心电图检查结果、治疗情况及随诊资料进行回顾性分析。结果(1)冠脉瘤患儿男性明显多于女性,男∶女为5.3∶1;冠脉巨大瘤男女比例为8.3∶1;<1岁患儿多发,占28.6%。(2)本组患儿中不完全KD、静脉注射丙种球蛋白(IVIG)抵抗以及KD复发的发生率均较高,分别为36.5%、30.2%和7.9%;急性期57例(90.5%)患儿使用IVIG冲击治疗,3例未用,3例使用情况不详;36例(57.1%)患儿发病至丙种球蛋白应用的时间间隔大于10d。(3)超声检查发现小冠脉瘤患儿7例,中等冠脉瘤19例,巨大瘤37例,左冠脉受累者占76.2%,其中58.3%发生在前降支;右冠脉受累者达87.3%,其中47.3%发生在右冠Ⅱ段;双侧冠脉同时受累者占63.5%。(4)随诊发现71.4%冠脉瘤呈现回缩趋势,45.2%的受累分支冠脉瘤消退,平均消退时间为(2.1±1.5)年。结论对于男性、发病年龄<1岁、不完全KD、发生IVIG抵抗、复发患儿及应用IVIG治疗较晚患儿要警惕冠脉瘤的发生;左冠前降支及右冠脉瘤样病变最多见,多数冠脉瘤在恢复期发生回缩。
Objective To analyze the clinical features of children with Kawasaki disease (KD) complicated with coronary artery disease (hereinafter referred to as coronary artery disease). Methods The clinical data, laboratory tests, ultrasonography and electrocardiogram findings, treatment and follow-up data of 63 KD children with coronary artery aneurysm diagnosed by Beijing Children’s Hospital Affiliated to Capital Medical University from 2000 to 2007 were retrospectively reviewed Sexual analysis. Results (1) The prevalence of coronary aneurysms was significantly higher in males than in males (5.3: 1 for males and females). The ratio of males to females was 8.3: 1 in patients with coronary lesions. The majority of children <1 year old accounted for 28.6%. (2) The incidence of incomplete KD, intravenous gamma globulin (IVIG) resistance and KD recurrence were all higher in this group (36.5%, 30.2% and 7.9% respectively); acute stage was 57.5% Three children were treated with IVIG, three were unused and three were not used. Thirty-six children (57.1%) had an application of gamma globulin for more than 10 days. (3) Ultrasound examination found that 7 cases of small coronary aneurysm, 19 cases of medium coronary aneurysm, 37 cases of giant tumor, left coronary artery involvement accounted for 76.2%, of which 58.3% occurred in the anterior descending artery; right coronary artery involvement Up to 87.3%, of which 47.3% occurred in the right coronary artery segment. The bilateral coronary arteries involved 63.5%. (4) Follow-up found that 71.4% of the coronary aneurysms showed a tendency of contracting, and 45.2% of the affected branches had subsided. The mean regression time was (2.1 ± 1.5) years. Conclusions In men, the incidence of coronary artery aneurysm should be vigilant in children with onset age <1 year, incomplete KD, IVIG resistance, recurrence and IVIG treatment. The left anterior descending coronary artery and right coronary artery lesions are the most See, the majority of coronary aneurysm retraction occurred in recovery.