Takahashi K, Oharaseki T, Naoe S
Department of Pathology, Ohashi Hospital, Toho University School of Medicine, Meguro, Tokyo, Japan.
Pediatr Cardiol. 2001 Mar-Apr;22(2):138-42. doi: 10.1007/s002460010180.
To clarify whether the cardiac sequelae of Kawasaki disease (KD), postcoronary arteritis lesions can become a risk factor for atherosclerosis of the coronary arteries, six autopsy cases of patients older than 15 years of age with coronary arterial lesions caused by arteritis in childhood were examined histologically. Twenty-four arteries were inspected: 10 had no evidence of aneurysm formation, 7 arteries manifested simple dilatation of the lumen, and in 7 arteries there were aneurysms with recanalization. In the group in which there were no aneurysms, "new intimal thickening" was observed in addition to the preexisting intimal thickening which had been caused by arteritis in the acute phase of KD. In the second group with aneurysmal arteries whose lumen remained dilated, thrombotic occlusion occurred in 4 of 6 aneurysms. In addition, advanced atherosclerotic changes (i.e., complicated lesions) were found in a 39-year-old patient. Finally, in the third group of arteries which manifested recanalized lumens after thrombotic occlusion of the aneurysms, new intimal thickening was seen on the internal side and some of them were occluded. The findings in this study suggest that aneurysms present in coronary arteries in individuals with a history of KD constitute a risk factor for atherosclerosis later in life.
为了阐明川崎病（KD）的心脏后遗症，即冠状动脉炎后病变是否会成为冠状动脉粥样硬化的危险因素，对6例15岁以上儿童期因动脉炎导致冠状动脉病变患者的尸检病例进行了组织学检查。共检查了24条动脉：10条无动脉瘤形成迹象，7条动脉仅表现为管腔单纯扩张，7条动脉存在动脉瘤且有再通现象。在无动脉瘤的组中，除了KD急性期动脉炎所致的原有内膜增厚外，还观察到“新内膜增厚”。在第二组有动脉瘤且管腔仍扩张的动脉中，6个动脉瘤中有4个发生了血栓性闭塞。此外，在一名39岁患者中发现了晚期动脉粥样硬化改变（即复杂病变）。最后，在第三组动脉瘤血栓性闭塞后管腔再通的动脉中，在内侧可见新内膜增厚，其中一些发生了闭塞。本研究结果表明，有KD病史个体的冠状动脉动脉瘤是其日后发生动脉粥样硬化的危险因素。
