Yonesaka S, Nakada T, Sunagawa Y, Tomimoto K, Naka S, Matubara T, Takahashi T, Furukawa H, Kamimura K
Kokyu To Junkan. 1989 Apr;37(4):429-33.
Since there has been many reports on the coronary artery lesions in the patients with Kawasaki disease, but only a few reports on histopathological investigation employing endomyocardial biopsy, histopathological study was performed in eighteen children of Kawasaki disease with coronary artery lesions and eighteen children of Kawasaki disease with intact coronary artery, aged from one year and ten months to fourteen years. There were twenty males and sixteen females. Comparing Kawasaki disease who had coronary artery lesions with those not, there was no striking difference in histologic findings. Kawasaki disease without coronary artery lesions revealed myocellular hypertrophy, degeneration of myocytes, disarray, interstitial fibrosis and endocardial changes in 44%, 61%, 11% and 44%, respectively. Among Kawasaki disease who had coronary artery lesions, children with coronary artery stenosis showed a higher incidence of histological abnormalities than those with coronary artery aneurysm. Some cases of Kawasaki disease were recognized to have significant myocardial abnormalities even in three to six years after onset, which seemed to persist whether or not they would have coronary artery lesions. Since Kawasaki disease who would have myocardial damages might have the potential for developing cardiomyopathy, careful attention should be payed to myocardial lesions as well as sequelae of coronary artery lesions.
尽管已有许多关于川崎病患者冠状动脉病变的报道,但采用心内膜心肌活检进行组织病理学研究的报道却很少。本研究对18例患有冠状动脉病变的川崎病患儿和18例冠状动脉正常的川崎病患儿进行了组织病理学研究,患儿年龄从1岁10个月至14岁。其中男性20例,女性16例。比较患有冠状动脉病变的川崎病患儿和未患冠状动脉病变的患儿,组织学表现无显著差异。无冠状动脉病变的川崎病患儿中,肌细胞肥大、心肌细胞变性、排列紊乱、间质纤维化和心内膜改变的发生率分别为44%、61%、11%和44%。在患有冠状动脉病变的川崎病患儿中,冠状动脉狭窄患儿的组织学异常发生率高于冠状动脉瘤患儿。部分川崎病患儿在发病3至6年后仍存在明显的心肌异常,无论是否会发生冠状动脉病变,这种异常似乎都会持续存在。由于可能发生心肌损伤的川崎病患儿有发展为心肌病的可能,因此应密切关注心肌病变以及冠状动脉病变的后遗症。