【摘要】 目的分析川崎病(KD)并发冠状动脉损害(CAL)患儿的临床特点,提高对本病的认识。方法对中国医科大学附属第一医院儿科2008年9月至2015年8月收治的19例诊断为KD并发CAL患儿的临床资料进行回顾性分析。结果 KD患儿并发CAL男性多于女性,男∶女为3.75∶1,其中冠状动脉瘤(CAA)患儿男性明显多于女性,男∶女为8∶1;小于1岁患儿多发,占36.8%。患儿CAL的发生率为16.4%;冠状动脉扩张(CAD)10例,CAA5例,巨大冠状动脉瘤(GCAA)4例,其发生率分别为8.6%、4.3%、3.5%;73.7%的患儿为病后2~3周发生CAL;按累及分支数计,累及双支冠状动脉占68.4%;按累及部位计,右冠状动脉受累占41.5%,左主干受累占39.0%,左前降支受累占17.1%,左回旋支受累占2.4%。患儿CAL的严重程度临床分级为:Ⅱ级病变5例,占26.3%;Ⅲ级病变8例,占42.1%;IV级病变6例,占31.6%。随访发现71.4%的患儿CAA或扩张呈明显回缩,回缩时间平均(1.5±0.7)年,其中1例CAA完全消退。结论 KD患儿并发CAL的发生率为16.4%,其中CAD比例最高,GCAA比例最低;CAL多发生在病后2~3周,各分支均可受损,最易累及右冠状动脉,CAL严重程度Ⅲ级的比例最高,多数CAA或扩张在1~2年内呈明显回缩。更多还原

【Abstract】 Objective To analyze the clinical characteristics of patients with CAL complicated by KD,and to improve the understanding of this disease. Methods Clinical data of 19 cases diagnosed as KD complicated by CAL from September 2008 to August 2015 in the Pediatric Department of First Hospital of China Medical University were retrospectively analyzed. Results KD children complicated with CAL was more in male than in female,male∶female was 3.75∶1;children with coronary aneurysm were more in male than in female,male:female was 8∶1;it was more often in less than 1-year old children,accounting for 36.8%. The incidence rate of coronary artery lesions in this group was16.4%;CAD was in 10 cases,CAA in 5 cases,GCAA in 4 cases,the incidence rate being 8.6%,4.3% and 3.5%,respectively;in terms of CAL time 73.7% was 2- 3 weeks after the disease;according to the number of branches involved,both coronary artery involved accounted for 68.4%,and according to the location involved,right coronary artery involvement accounted for 41.5%,left main coronary artery involvement accounted for 39.0%,the left anterior descending coronary artery involvement accounted for 17.1%,and left circumflex artery involvement accounted for 2.4%.The clinical grade of severity in CAL children were:Ⅱ grade in 5 cases,accounting for 26.3%;Ⅲ grade in 8 cases,accounting for 42.1%;Ⅳ grade in 6 cases,accounting for 31.6%. During follow-up,71.4% patients had coronary artery aneurysm or dilatation significantly retracted,the average time of retraction being(1.5±0.7)years,of which 1 case was completely dissipated. Conclusion The incidence rate of the KD patients with CAL is 16.4%,in which CAD has the highest incidence rate while GCAA the lowest. CAL mostly occurs at 2-3 weeks after the disease. Any branch can be damaged,with the right coronary artery to be most likely involved. As to coronary artery disease severity,grade Ⅲ is of the highest proportion. Most coronary artery aneurysm or dilatation has remarkable retraction within 1-2 years.更多还原