Wilson N, Heaton P, Calder L, Nicholson R, Stables S, Gavin R
Paediatric Cardiology, Green Lane Hospital, Auckland 1030, New Zealand.
J Paediatr Child Health. 2004 Sep-Oct;40(9-10):524-9. doi: 10.1111/j.1440-1754.2004.00456.x.
To review recent cases of Kawasaki disease (KD) with significant cardiac sequelae in New Zealand. It is known that intravenous immunoglobulin (IVIG) reduces the risk of coronary artery aneurysm formation if given within 8-10 days of onset of KD.
Retrospective review of medical course, criteria for KD, laboratory and cardiac findings for six children identified with KD and significant coronary artery sequelae.
There was delay in diagnosis of KD in three of the six children. Three cases were atypical by extremes of age (2 months, 10 years, 14 years). By definition all six children had significant coronary artery involvement. One patient had a thrombus detected in a coronary aneurysm 3 weeks after KD. One patient underwent coronary artery bypass grafting for unstable angina 2 years after KD. One patient developed coronary artery aneurysms after an initial 'toxic shock' type illness evolving to KD. Three patients died, one due to rupture of a coronary artery aneurysm, two from rapid early coronary artery obstruction occurring at three and 4 months after initial KD.
Kawasaki disease remains an important cause of mortality and morbidity for children. Diagnostic delay beyond 8 days reduces the chances of successful IVIG therapy in KD. Current studies supported by the Paediatric Surveillance Unit should establish the epidemiology of KD in New Zealand.
回顾新西兰近期患有严重心脏后遗症的川崎病（KD）病例。已知静脉注射免疫球蛋白（IVIG）若在KD发病8 - 10天内给予，可降低冠状动脉瘤形成的风险。
对6例确诊为KD且有明显冠状动脉后遗症的儿童的病程、KD诊断标准、实验室检查及心脏检查结果进行回顾性分析。
6例儿童中有3例KD诊断延迟。3例为非典型病例，年龄分别为2个月、10岁和14岁。根据定义，所有6例儿童均有明显冠状动脉受累。1例患者在KD发病3周后冠状动脉瘤内检测到血栓。1例患者在KD发病2年后因不稳定型心绞痛接受冠状动脉搭桥手术。1例患者在最初的“中毒性休克”样疾病演变为KD后出现冠状动脉瘤。3例患者死亡，1例死于冠状动脉瘤破裂，2例死于初次KD发病3个月和4个月后早期快速冠状动脉阻塞。
川崎病仍然是儿童发病和死亡的重要原因。诊断延迟超过8天会降低KD患者接受IVIG治疗成功的几率。由儿科监测单位支持的当前研究应确定新西兰KD的流行病学情况。
