Levy Deborah M, Silverman Earl D, Massicotte M Patricia, McCrindle Brian W, Yeung Rae S M
Departments of Pediatrics, Division of Rheumatology, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada.
J Rheumatol. 2005 May;32(5):928-34.
Kawasaki disease (KD) has potentially serious cardiac complications including coronary artery aneurysms. Children who develop giant aneurysms (GA) are at increased risk of thrombosis and ischemia, and although longterm oral anticoagulation with warfarin is recommended, its efficacy has not been studied. We examined the longterm outcome of patients with GA secondary to KD, to determine if anticoagulation with warfarin aids in the prevention of myocardial ischemia.
We studied patients with KD followed between May 1990 and April 2000.
Thirty-nine GA occurred in 2.2% of patients with KD (22/997 patients), and 33 non-GA were also identified in these patients. Patients were divided into 2 groups, those taking warfarin and no warfarin. Most patients in both groups were also taking antiplatelet agents. The demographics of the 2 groups were statistically similar, except the median duration of followup was significantly longer for patients in the no-warfarin group (6.9 vs 13.3 yrs; p = 0.008). Four early ischemic events (< 1 year after KD diagnosis) occurred (3 myocardial infarctions and one stroke). Screening for late ischemic events by stress nuclear medicine myocardial perfusion imaging revealed only one patient, in the no-warfarin group, with reversible perfusion defects. No patient had clinical signs or symptoms of late myocardial ischemia. Echocardiographic regression of aneurysms was observed in both groups. In the warfarin vs no-warfarin group, the diameters of the GA regressed a median 22% vs 32% (p = 0.27), and non-GA regressed a median of 30% vs 25% (p = 0.61). Compliance with anticoagulation was good, and no major bleeding complication of anticoagulation occurred.
Regression of GA occurred in most of our patients, and minimal late ischemia was observed. Further studies are required to evaluate the use of oral anticoagulation in patients with GA secondary to KD.
川崎病（KD）可引发包括冠状动脉瘤在内的潜在严重心脏并发症。发生巨大动脉瘤（GA）的儿童发生血栓形成和局部缺血的风险增加，尽管推荐使用华法林进行长期口服抗凝治疗，但其疗效尚未得到研究。我们研究了KD继发GA患者的长期预后，以确定华法林抗凝是否有助于预防心肌缺血。
我们研究了1990年5月至2000年4月期间随访的KD患者。
KD患者中有2.2%（22/997例患者）发生了39个GA，这些患者中还发现了33个非GA。患者分为两组，即服用华法林组和未服用华法林组。两组中的大多数患者也在服用抗血小板药物。两组的人口统计学特征在统计学上相似，但未服用华法林组患者的中位随访时间明显更长（6.9年对13.3年；p = 0.008）。发生了4例早期缺血事件（KD诊断后<1年）（3例心肌梗死和1例中风）。通过负荷核医学心肌灌注成像筛查晚期缺血事件仅发现1例患者，在未服用华法林组，有可逆性灌注缺损。没有患者出现晚期心肌缺血的临床体征或症状。两组均观察到动脉瘤的超声心动图缩小。在服用华法林组与未服用华法林组中，GA的直径中位缩小了22%对32%（p = 0.27），非GA的直径中位缩小了30%对25%（p = 0.61）。抗凝治疗的依从性良好，未发生抗凝的严重出血并发症。
我们的大多数患者GA出现缩小，且观察到极少的晚期缺血情况。需要进一步研究以评估口服抗凝在KD继发GA患者中的应用情况。
