Long-term changes in coronary artery aneurysms in patients with Kawasaki disease - Comparison of therapeutic regimens
Long-term changes in coronary artery aneurysms in patients with Kawasaki disease - Comparison of therapeutic regimens
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DOI：
10.1253/circj.69.265
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发表时间：
2005-03-01
影响因子：
3.3
通讯作者：
Kiyosawa, N
中科院分区：
文献类型：
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作者：
Onouchi, Z;Hamaoka, K;Kiyosawa, N
背景预防川崎病(KD)动脉瘤狭窄转化的治疗方案研究较少。本研究的目的是评价急性期和恢复期至慢性期综合治疗对狭窄病变形成的预防作用。方法与结果对85例患者的103个巨大动脉瘤(ANI)、46个中型动脉瘤(ANM)和13个小型动脉瘤(ANS)进行分析。在急性期治疗方面，接受大剂量丙种球蛋白治疗(G)的患者未发现左冠状动脉局限性ANI狭窄。对于ANM，(G)组的消退率明显高于阿司匹林组和类固醇组。此外，使用阿司匹林和华法林预防方案未发生冠状动脉闭塞/再通。与华法林预防方案和不预防方案相比，预防方案和单独使用阿司匹林的方案{a}显著降低了发病率。结论川崎病急性期大剂量丙种球蛋白治疗是预防狭窄转化的首选方案。对于ANI，建议使用预防措施。
Background There are few studies of the therapeutic regimens for the prevention of stenotic transformation of aneurysms in Kawasaki disease (KD). The aim of this Study was to assess the prophylactic effect of combined therapy in the acute stage and convalescent- to chronic-stage against the formation of stenotic lesions.Methods and Results In 85 patients, 103 giant aneurysms (ANI), 46 medium-sized aneurysms (ANm), and 13 small aneurysms (ANs) were analyzed. With respect to therapy in the acute stage, no localized stenosis of ANI in the left coronary artery was noted in patients who received high-dose gamma globulin therapy (G). For ANm, the group (G) showed a significantly higher regression rate than the aspirin group and steroids group. Furthermore, no coronary artery occlusion/recanalization of ANI occurred with the prophylactic regimen of aspirin and warfarin {aw}. Prophylaxis {aw} and the prophylactic regimen of aspirin alone {a} significantly lowered the incidence compared with either the prophylactic regimen of warfarin {w} or no prophylaxis {n}. However, no significant differences were noted between prophylaxis {w} and {n},Conclusions High-dose gamma globulin therapy in the acute stage of KD is the first choice for the prevention of stenotic transformation. Prophylaxis {aw} is, recommended for ANI.