de Zorzi A, Colan S D, Gauvreau K, Baker A L, Sundel R P, Newburger J W
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
J Pediatr. 1998 Aug;133(2):254-8. doi: 10.1016/s0022-3476(98)70229-x.
Current American Heart Association guidelines indicate that patients with Kawasaki disease and no coronary artery abnormalities on echocardiography at any stage of illness may be discharged from cardiologic follow-up 1 year after onset of illness.
To determine whether coronary artery dimensions in patients with Kawasaki disease whose vessels are classified as "normal" by Japanese Ministry of Health criteria have a distribution similar to expected population norms when adjusting for body surface area, we studied 125 patients during 4 intervals from onset of illness: (1) 10 days or less, (2) 2 weeks (11 to 21 days), (3) 6 weeks (22 days to 3 months), and (4) 1 year (4 months to 1.5 years). Using two-dimensional echocardiography, we measured the internal lumen diameter of the left main, proximal left anterior descending, and proximal right coronary arteries. Mean body surface area-adjusted dimensions of the proximal left anterior descending and right coronary arteries were significantly larger (P < .01) in patients with Kawasaki disease than those in subjects in all periods, except for a marginal difference at 6 weeks for the proximal right coronary artery (P = .02); for the left main coronary artery, this difference achieved statistical significance in the period of 10 days or less, with a trend at 2 weeks (P = .02). Among patients classified as having normal coronary arteries on all echocardiograms by the Japanese Ministry of Health criteria, 27% had at least 1 body surface area-adjusted coronary dimension more than 2 standard deviations above the expected mean.
Coronary artery dilation in Kawasaki disease is thus more prevalent than previously reported, highlighting the need for systematic long-term surveillance of this population.
美国心脏协会当前指南指出，患川崎病且在疾病任何阶段经超声心动图检查无冠状动脉异常的患者，可在发病1年后停止心脏科随访。
为确定按照日本厚生省标准血管被归类为“正常”的川崎病患者，在调整体表面积后其冠状动脉尺寸分布是否与预期人群标准相似，我们在患者发病后的4个时间段对125例患者进行了研究：（1）10天及以内；（2）2周（11至21天）；（3）6周（22天至3个月）；（4）1年（4个月至1.5年）。我们使用二维超声心动图测量了左主干、左前降支近端和右冠状动脉近端的管腔内径。川崎病患者左前降支近端和右冠状动脉近端经体表面积调整后的平均尺寸，在所有时间段均显著大于对照组（P <.01），右冠状动脉近端在6周时差异不显著（P =.02）；左主干冠状动脉在10天及以内差异有统计学意义，在2周时有差异趋势（P =.02）。按照日本厚生省标准所有超声心动图均显示冠状动脉正常的患者中，27%至少有1个经体表面积调整后的冠状动脉尺寸超过预期平均值2个标准差以上。
因此，川崎病患者冠状动脉扩张比之前报道的更为普遍，这凸显了对该人群进行系统长期监测的必要性。
