Alves Natália Ribeiro de M, Magalhães Cristina Medeiros R de, Almeida Roseane de Fátima R, Santos Regina Cândido R Dos, Gandolfi Lenora, Pratesi Riccardo
Unidade de Reumatologia Pediátrica, Hospital de Base de Brasília, Brasília.
Rev Assoc Med Bras (1992). 2011 May-Jun;57(3):295-300.
To draw attention to complications that might arise in any Kawasaki disease (KD) stage, risk factors contributing to the onset of complications and possible transient or permanent disease sequelae.
Prospective study (clinical cohort) conducted between April 2002 and April 2009 of 115 patients with KD admitted to the Pediatric Rheumatology Clinic of the General Hospital of the Federal District, Brazil. All patients were sequentially assessed with clinical and laboratory examinations, Doppler echocardiography, imitanciometry, auditory evoked potentials, psychological evaluation, ophthalmologic examination and, in one patient with chorea, cerebral magnetic resonance angiography. In all patients, a questionnaire assessing the possible presence of cognitive, emotional, behavioral and social disorders was applied.
Twenty-five patients (21.7%) had coronary aneurisms. Thirty eight patients (33%) had a sensorineural auditory loss during the acute and subacute phases of the disease and 13 patients (11.3%) maintained the auditory loss six months after the first assessment. Other complications observed were as follows: facial palsy in one patient (0.9%), ataxia in acute and subacute phases in 11 (9.5%); 15 patients had ophthalmologic complications (13.2%), with uveitis in 13, papilledema in one patient, and conjunctival hemorrhage in another patient. One patient experienced chorea (0.9%), with a magnetic resonance angiography showing changes consistent with cerebral ischemia. In one patient, a thoracic aorta aneurism was found (0.9%) and another patient had a necrotizing vasculitis progressing to peripheral gangrene and tongue tip loss (0.9%). Behavioral changes over convalescence were observed in 23 children.
KD may progress with several complications even within months of the disease acute phase, eventually resulting in permanent sequelae. The earlier the diagnosis and therapeutic intervention with IV IgG administration are, the lower will be the occurrence of complications; the presence of thrombocytosis, anemia and elevated and extended inflammatory activity are risk factors for complication arising.
提醒人们注意川崎病（KD）任何阶段可能出现的并发症、导致并发症发生的危险因素以及可能的短暂性或永久性疾病后遗症。
对2002年4月至2009年4月期间入住巴西联邦区综合医院儿科风湿病诊所的115例KD患者进行前瞻性研究（临床队列研究）。所有患者均依次接受临床和实验室检查、多普勒超声心动图、阻抗测量、听觉诱发电位、心理评估、眼科检查，其中1例舞蹈症患者还接受了脑磁共振血管造影检查。对所有患者应用一份评估认知、情感、行为和社会障碍可能存在情况的问卷。
25例患者（21.7%）患有冠状动脉瘤。38例患者（33%）在疾病的急性期和亚急性期出现感音神经性听力损失，13例患者（11.3%）在首次评估6个月后仍存在听力损失。观察到的其他并发症如下：1例患者出现面神经麻痹（0.9%），11例患者在急性期和亚急性期出现共济失调（9.5%）；15例患者出现眼科并发症（13.2%），其中13例为葡萄膜炎，1例为视乳头水肿，另1例为结膜出血。1例患者出现舞蹈症（0.9%），磁共振血管造影显示与脑缺血一致的改变。1例患者发现胸主动脉瘤（0.9%），另1例患者患有坏死性血管炎，进展为周围坏疽和舌尖缺失（0.9%）。23例儿童在恢复期出现行为改变。
即使在疾病急性期数月内，KD也可能进展为多种并发症，最终导致永久性后遗症。诊断和静脉注射免疫球蛋白治疗干预越早，并发症的发生率就越低；血小板增多、贫血以及炎症活动升高和持续是并发症发生的危险因素。
