PATHOLOGICAL FEATURES OF CORONARY-ARTERIES IN CHILDREN WITH KAWASAKI DISEASE IN WHICH CORONARY ARTERIAL ANEURYSM WAS ABSENT AT AUTOPSY - QUANTITATIVE-ANALYSIS
PATHOLOGICAL FEATURES OF CORONARY-ARTERIES IN CHILDREN WITH KAWASAKI DISEASE IN WHICH CORONARY ARTERIAL ANEURYSM WAS ABSENT AT AUTOPSY - QUANTITATIVE-ANALYSIS
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DOI：
10.1161/01.cir.78.2.345
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发表时间：
1988-08-01
期刊：
影响因子：
37.8
通讯作者：
NAKANO, H
中科院分区：
文献类型：
--
作者：
FUJIWARA, T;FUJIWARA, H;NAKANO, H
本文对6例川崎病患儿的冠状动脉进行了检查。4名儿童在急性期死于心肌炎，2名儿童死于细菌性败血症，或死于痊愈阶段电影血管造影术中的事件。并以21例非川崎病患儿为对照。6例川崎病患儿均无血栓形成、血管再通或主干冠状动脉狭窄超过50%。3例患者急性期冠状动脉主干扩张。三名患者中有两名在急性期死亡，自检显示冠状动脉轻微扩张，因泛血管炎而出现异常的内膜增厚。在第三个孩子中，他在痊愈阶段死亡，急性期二维超声心动图检测到的冠状动脉扩张在痊愈阶段消失。尸检未见冠状动脉主干扩张。但冠状动脉主干内膜纤维异常增厚，未见炎性改变。另3例患者急性期冠状动脉主干未见扩张。急性期死亡2例，内膜和外膜轻度炎症，无异常增厚。在第三位患者，他在愈合阶段死亡，二维超声心动图显示在临床过程中没有扩张，尸检时也没有炎性变化或异常的内膜增厚。我们的结论是，在川崎病患者中，即使在急性期没有冠状动脉扩张的患者也存在主要冠状动脉的血管炎，而异常的冠状动脉内膜增厚可能在愈合期仍存在，也可能不存在。无冠状动脉瘤的川崎病与有冠状动脉瘤的川崎病具有相同的病理实体。
Coronary arteries in six children who had Kawasaki disease but lacked coronary arterial aneurysms were examined. Four children died of myocarditis at the acute stage, and two children died of bacterial sepsis or as a results of an occurrence during cineangiography at the healed stage. Twenty-one children without Kawasaki disease were examined as controls. The six children with Kawaski disease had no thrombi, recanalization, or stenosis greater than 50% in the major coronary arteries. Three patients had dilatation of the major coronary arteries at the acute stage. Two of the three patients died during the acute stage, and autompsy showed slight dilatation of coronary arteries and abnormal intimal thickening due to panvasculitis. In the third child, who died at the healed stage, dilatation of the coronary arteries detected by two-dimenisional echocardiography at the acute stage had disappeared at the healed stage. No dilatation of the major coronary arteries was seen at autopsy. However, abnormal fibrous intimal thickening of the major coronary arteries without inflammatory changes was found. The other three patients had no dilatation of the major coronary arteries at the acute stage. Two patients died at the acute stage, and slight inflammation without abnormal intimal thickening was seen in the intima and the adventitial area. In the third patient, who died during the healed stage, two-dimensional echocardiography revealed no dilatation during the clinical course, and there was no inflammatory changes or abnormal intimal thickening at autopsy. We conclude that in Kawasaki disease, vasculitis of the major coronary arteries is present even in patients without coronary dilatation at the acute stage, and the abnormal initmal thickening may or may not remain at the healed stage. Kawasaki disease without coronary aneurysm has the same pathological entity as Kawaski disease with coronary aneurysm.