Salice P, Pietrogrande M C, Barbier P, Ghiglia S, Laicini E, Fesslova V
Sezione di Cardiologia Pediatrica, Servizio di Cardiologia, Istituti Clinici di Perfezionamento, Milano.
Cardiologia. 1998 Dec;43(12):1367-74.
We report a prospective study performed over a 9 year period in 96 children with Kawasaki disease (mean age 35 +/- 29 months), 84 of whom < 5 years of age. The male/female ratio was 1.5 (57/39). A total of 38 patients had cardiac involvement, including flattened T waves in the ECG (10 patients), pericardial effusion (6 patients), myocarditis (1 patient), and coronary artery aneurysms (25 patients; frequency of aneurysms: 26%). All patients were evaluated during the acute phase (first month) of the illness. The first echocardiographic examination was performed 15 days (range 4.30 days) from the appearance of fever, and coronary aneurysms were observed in 23 patients; in 2 patients, however, aneurysms appeared later (2 and 6 months). Aneurysms were small (< or = 4.5 mm) in 12, medium (4.5-7 mm) in 11, and large (> 7 mm) in 12 patients. Male sex (p = 0.02), age < 12 months (p = 0.005), ESR (p = 0.001), platelet count (p = 0.009), and pericardial effusion (p = 0.02) were significantly related to the presence of aneurysm. Among females, incidence of aneurysms was significantly higher in infants < 12 months than in older patients (60 vs 6%, p < 0.001). Intravenous immunoglobulin treatment was started early (within 10 days) in 61 patients and late (> 10 days) in 22. Compared to late treatment, early i.v. immunoglobulin treatment was associated with smaller aneurysms and higher regression rate (67 vs 28%, p < 0.05). No difference was observed concerning frequency and number of dilated vessels as related to therapeutical regimens. Total i.v. immunoglobulin dose (2 g/kg) was administered over 1-2 days in 26 patients (scheme I) or over 4-5 days in 58 (scheme II). Frequency of aneurysms was significantly lower in patients treated early (p = 0.02). No myocardial infarctions or deaths occurred at short- or long-term follow-up.
我们报告了一项在96例川崎病患儿中进行的为期9年的前瞻性研究（平均年龄35±29个月），其中84例年龄小于5岁。男女比例为1.5（57/39）。共有38例患者有心脏受累，包括心电图T波低平（10例）、心包积液（6例）、心肌炎（1例）和冠状动脉瘤（25例；动脉瘤发生率：26%）。所有患者在疾病急性期（第一个月）接受评估。首次超声心动图检查在发热出现后15天（范围4 - 30天）进行，23例患者观察到冠状动脉瘤；然而，2例患者的动脉瘤出现较晚（2个月和6个月）。12例患者的动脉瘤较小（≤4.5 mm），11例为中等大小（4.5 - 7 mm），12例为大动脉瘤（>7 mm）。男性（p = 0.02）、年龄<12个月（p = 0.005）、血沉（p = 0.001）、血小板计数（p = 0.009）和心包积液（p = 0.02）与动脉瘤的存在显著相关。在女性中，<12个月婴儿的动脉瘤发生率显著高于年龄较大的患者（60%对6%，p < 0.001）。61例患者早期（10天内）开始静脉注射免疫球蛋白治疗，22例患者晚期（>10天）开始治疗。与晚期治疗相比，早期静脉注射免疫球蛋白治疗与较小的动脉瘤和较高的消退率相关（67%对28%，p < 0.05）。在与治疗方案相关的扩张血管频率和数量方面未观察到差异。26例患者在1 - 2天内给予静脉注射免疫球蛋白总剂量（2 g/kg）（方案I），58例患者在4 - 5天内给予（方案II）。早期治疗患者的动脉瘤发生率显著较低（p = 0.02）。在短期或长期随访中未发生心肌梗死或死亡。
