单中心338例川崎病并发冠状动脉瘤的超声诊断与随访分析

摘要

Objective To investigate the diagnosis and prognosis of patients with coronary artery aneurysm in Kawasaki disease.Methods The data of ultrasonic diagnosis and follow-up of 338 children with Kawasaki disease complicated with coronary artery aneurysms were analyzed.Results The incidence of coronary artery aneurysm in the acute stage of Kawasaki disease was 21.2％ (338/1 594).Of all the 338 cases,small aneurysms was 66.6％ (225 cases),medium aneurysms was 25.1％ (85 cases),and giant aneurysms was 8.3％ (28 cases).There were 719 branches involved in 338 cases,32.8％ of them in left main coronary artery and 31.1％ in right coronary artery;25.3％ in left anterior descending branch,and 10.8％ in left circumflex branch.A total of 382 branches were followed up,including 218 branches of small coronary aneurysm group and 82.1％ of them were completely recovered to the normal diameter.The medium aneurysm group was 124 brunches,the proportion of no significant change,retraction,and normal were 23.4％,68.5％ and 8.1％,respectively.There were 40 brunches in the giant anuerysm group,in which the proportion of no significant change,retraction,and normal were 70.0％,27.5％ and 2.5％,respectively.A total of 30 thrombosiswere detected by echocardiography in the acute stage,20 thrombosis were regularly followed up,12 thrombosis gradually subsided,and the other remained persist.Five thrombosis were detected in the sequelae stage,and all located in the giant coronary aneurysm.Seven children were clinically diagnosed with ischemic heart disease,of them,acute myocardial infarction in 1 case,1 died of heart failure.Conclusions Kawasaki disease coronary artery disease are common in small coronary aneurysms,of which the left main artery and right coronary artery lesions are the most common,and the prognosis is better;medium and giant aneurysm need more time to recovery,and are easy to complicated with thrombosis.%目的 分析川崎病急性期并发冠状动脉瘤患儿的超声心动图表现及转归情况.方法 对2010-2015年北京儿童医院收治338例川崎病急性期并发冠状动脉瘤患儿的超声心动图资料进行回顾性分析.结果 川崎病急性期冠状动脉瘤的发生率约21.2％ (338/1 594),338例冠状动脉瘤患儿中,小型瘤225例(66.6％),中型瘤85例(25.1％),巨大瘤28例(8.3％).共有719支冠状动脉并发瘤样病变,常见受累分支依次为左主干(32.8％)、右冠脉(31.1％)、左前降支(25.3％)、左回旋支(10.8％).有效随访382支(188例),小型瘤组218支,至随访终点内径恢复正常的比例为82.1％;中型瘤组124支,内径无明显变化、内径缩小、恢复正常的比例分别为23.4％、68.5％、8.1％;巨大瘤组40支,大小无明显变化、内径缩小、恢复正常的比例分别为70.0％、27.5％、2.5％.急性期冠状动脉瘤伴血栓形成者26例(30处),随访20处血栓发现,12处逐渐消退,余持续存在.另5例巨大瘤患儿在随访过程中新发血栓.临床诊断缺血性心肌病7例,其中急性心肌梗死1例,1例死于心源性休克.结论 川崎病冠状动脉病变以小冠状动脉瘤最常见,以左主干及右冠状动脉病变为主,预后较好;中等以上冠状动脉瘤恢复时间较长,易并发血栓及其他心血管并发症.