Burns J C, Shike H, Gordon J B, Malhotra A, Schoenwetter M, Kawasaki T
Kawasaki Disease Research Program, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, 92093-0609, USA.
J Am Coll Cardiol. 1996 Jul;28(1):253-7. doi: 10.1016/0735-1097(96)00099-x.
Kawasaki disease is an acute vasculitis of unknown etiology that predominantly affects children <5 years of age. Structural damage to the coronary arteries after the acute, self-limited illness is detected by echocardiography in approximately 25% of untreated patients. The long-term effects of the acute coronary arteritis are unknown. To define the spectrum of clinical disease in young adults that can be attributed to Kawasaki disease in childhood, we performed a retrospective survey of cases reported in the English and Japanese published data of adult coronary artery disease attributed to antecedent Kawasaki disease. The mean age at presentation with cardiac sequelae was 24.7 +/- 8.4 years (range 12 to 39) for the 74 patients identified with presumed late sequelae of Kawasaki disease. Symptoms at the time of presentation with cardiac sequelae included chest pain/myocardial infarction (60.8%), arrhythmia (10.8%) and sudden death (16.2%). These symptoms were precipitated by exercise in 82% of patients. One-third of the patients in whom a chest radiograph was taken had ring calcification. Angiographic findings included coronary artery occlusion (66.1%). Extensive development of collateral vessels was reported in 44.1% of patients. Autopsy findings included coronary artery aneurysms (100%) and coronary artery occlusion (72.2%). The acute vasculitis of Kawasaki disease can result in coronary artery damage and rheologic changes predisposing to thrombus formation or progressive atherosclerotic changes that may remain clinically silent for many years. Coronary artery aneurysms and calcification on chest radiography were unusual features in this group of patients. A history of antecedent Kawasaki disease should be sought in all young adults who present with acute myocardial infarction or sudden death.
川崎病是一种病因不明的急性血管炎，主要影响5岁以下儿童。在急性自限性疾病发作后，约25%未经治疗的患者通过超声心动图检测到冠状动脉结构损伤。急性冠状动脉炎的长期影响尚不清楚。为了明确可归因于儿童期川崎病的年轻成人临床疾病谱，我们对英文和日文发表的归因于既往川崎病的成人冠状动脉疾病数据中报告的病例进行了回顾性调查。在74例被确定为川崎病可能的晚期后遗症患者中，出现心脏后遗症的平均年龄为24.7±8.4岁（范围12至39岁）。出现心脏后遗症时的症状包括胸痛/心肌梗死（60.8%）、心律失常（10.8%）和猝死（16.2%）。82%的患者这些症状由运动诱发。三分之一进行胸部X线检查的患者有环状钙化。血管造影结果包括冠状动脉闭塞（66.1%）。44.1%的患者报告有广泛的侧支血管形成。尸检结果包括冠状动脉瘤（100%）和冠状动脉闭塞（72.2%）。川崎病的急性血管炎可导致冠状动脉损伤和血液流变学改变，易引发血栓形成或进行性动脉粥样硬化改变，这些改变可能在临床上多年无症状。冠状动脉瘤和胸部X线钙化在这组患者中是不寻常的特征。所有出现急性心肌梗死或猝死的年轻成人都应询问是否有既往川崎病病史。
