Prognosis of Coronary Arterial Lesions in Kawasaki Disease Treated without Intravenous Immunoglobulin

未接受靜脈免疫球蛋白川崎症病兒合併冠狀動脈病變之預後

鄭光志(Kuang-Tsu Tzen) ； 吳美環(Mei-Hwan Wu) ； 王主科(Jou-Kou Wang) ； 呂鴻基(Hung-Chi Lue) ； 李慶雲(Chin-Yun Lee) ； 簡淑卿(Su-Chin Chien)

《Acta Paediatrica Sinica》 38卷1期 (1997/02) Pp. 32-37

https://doi.org/10.7097/APS.199702.0032

摘要

From 1981 to 1989, a total of 86 consecutive patients with definite Kawasaki disease who received aspirin but not intravenous immunoglobulin (IVIG) therapy during the acute stage were studied. Thirty-eight of them (44%) had coronary arterial lesion (CAL) on initial two-dimensional echocardiograms. Of them, 21(56%) had ectatic coronary changes, 13 (34%) had small to large coronary aneurysms (diameter 8mm) and 4 (10%), giant coronary aneurysms (diameter＞8mm). Patients with CAL had, in the acute stage, a longer duration of fever (p＜0.0l), higher maximum platelet counts (p＜0.05) and a higher one-hour erythrocyte sedimentation rate (＜0.01) than those without. Males were associated with a higher incidence of aneurysmal dilatation of the CAL. By actuarial event-free analysis, more than half of the ectatic coronary lesions regressed within two months of onset, and 86% became normal on echocardiograms within a two-year follow-up period. Ectatic lesions had a significantly higher chance of regression than aneurysmal lesions (p＜0.0l). Furthermore, none of the giant aneurysms regressed (p＜0.05, as compared with those coronary aneurysms smaller than 8 mm in diameter). It was concluded that coronary arterial lesions occurred in a substantial number of Chinese children with Kawasaki disease who received only aspirin therapy. Regression of the lesions was related to their size and morphology.

關鍵字

川崎症 ； 冠狀動脈病變 ； aspirin

並列摘要

From 1981 to 1989, a total of 86 consecutive patients with definite Kawasaki disease who received aspirin but not intravenous immunoglobulin (IVIG) therapy during the acute stage were studied. Thirty-eight of them (44%) had coronary arterial lesion (CAL) on initial two-dimensional echocardiograms. Of them, 21(56%) had ectatic coronary changes, 13 (34%) had small to large coronary aneurysms (diameter 8mm) and 4 (10%), giant coronary aneurysms (diameter＞8mm). Patients with CAL had, in the acute stage, a longer duration of fever (p＜0.0l), higher maximum platelet counts (p＜0.05) and a higher one-hour erythrocyte sedimentation rate (＜0.01) than those without. Males were associated with a higher incidence of aneurysmal dilatation of the CAL. By actuarial event-free analysis, more than half of the ectatic coronary lesions regressed within two months of onset, and 86% became normal on echocardiograms within a two-year follow-up period. Ectatic lesions had a significantly higher chance of regression than aneurysmal lesions (p＜0.0l). Furthermore, none of the giant aneurysms regressed (p＜0.05, as compared with those coronary aneurysms smaller than 8 mm in diameter). It was concluded that coronary arterial lesions occurred in a substantial number of Chinese children with Kawasaki disease who received only aspirin therapy. Regression of the lesions was related to their size and morphology.

並列關鍵字

Kawasaki disease ； coronary arterial lesion ； aspirin ； IVIG