川崎病患者随访评估中超声心动图的推荐频率。

Lee Meng-Hsun, Dai Zen-Kong, Lee Min-Sheng, Hsu Jong-Hau, Chuang Hung-Yi, Wu Jiunn-Ren

Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Acta Paediatr Taiwan. 2005 Nov-Dec;46(6):346-51.

To assess the value of follow-up echocardiograms for patients with Kawasaki disease (KD). During a period of 5 years, children diagnosed with KD were enrolled in this study if at least three echocardiograms were documented, including one at admission, one at 1 to 2 months and one beyond 2 months following the onset of fever. The cohort study recruited 176 patients, and 120 patients were included in the final analysis. Most (116 patients, 97%) of the patients were under 5 years of age, and the male-to-female ratio was 1.93: 1. During the study period, KD was more common during the summer (35.8%). Of the 120 patients, 67 (56%) had normal echocardiograms, and 53 (44%) had abnormal echocardiograms at admission. Of the 53 patients with abnormal echocardiograms, 35 had coronary artery dilatation, and 18 had aneurysm. The mean interval between the onset of illness and the documentation of echocardiographic abnormality was 13 days (range 3-37 days). The abnormal echocardiographic findings resolved in 48 of the 53 (90%) patients in 2 years. No patient who had normal echocardiographic findings at 1-2 months developed subsequent abnormalities. There was no difference in the proportion of persistent abnormal follow-up echocardiographic findings in patients with initial coronary dilatation or aneurysm between the 2m-6m and 6m-12m follow-up echocardiograms (p = 0.78, p = 0.09, respectively). The proportion of patients with echocardiographic findings of coronary dilatation and aneurysm changed significantly between the 2m-6m and 12m-18m follow-up echocardiograms (p = 0.007, p = 0.045, respectively). Additional echocardiographic studies beyond 8 weeks for coronary artery morphology are not necessary if previous studies have produced normal results in patients with KD. Patients who have coronary artery abnormalities at the acute or subacute stage should receive an additional follow-up echocardiogram one year after the convalescent stage of the disease.

评估川崎病（KD）患者随访超声心动图的价值。在5年期间，若至少记录了三次超声心动图检查结果，包括发热开始时的一次入院检查、1至2个月时的一次检查以及发热开始后2个月后的一次检查，则将诊断为KD的儿童纳入本研究。队列研究招募了176名患者，最终分析纳入了120名患者。大多数患者（116名，97%）年龄在5岁以下，男女比例为1.93:1。在研究期间，KD在夏季更为常见（35.8%）。120名患者中，67名（56%）入院时超声心动图检查结果正常，53名（44%）异常。在53名超声心动图检查结果异常的患者中，35名有冠状动脉扩张，18名有动脉瘤。疾病发作至超声心动图异常记录的平均间隔时间为13天（范围3 - 37天）。53名患者中有48名（90%）在2年内超声心动图异常结果消失。在1至2个月时超声心动图检查结果正常的患者中，无一人随后出现异常。在2个月至6个月和6个月至12个月的随访超声心动图检查中，初始有冠状动脉扩张或动脉瘤的患者持续超声心动图异常结果的比例无差异（分别为p = 0.78，p = 0.09）。在2个月至6个月和12个月至18个月的随访超声心动图检查中，冠状动脉扩张和动脉瘤的超声心动图检查结果比例有显著变化（分别为p = 0.007，p = 0.045）。如果之前对KD患者的研究结果正常，那么在8周后进行额外的冠状动脉形态超声心动图检查没有必要。在疾病急性期或亚急性期有冠状动脉异常的患者，在疾病恢复期一年后应接受额外的超声心动图随访检查。