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Microcirculation and microstructure of coronary beds in Kawasaki Disease

川崎病冠状动脉床的微循环和微结构

基本信息

批准号：
04670611
负责人：
HAMAOKA Kenji
金额：
$ 0.96万
依托单位：
Kyoto Prefectural University of Medicine
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1992
资助国家：
日本
起止时间：
1992 至 1993
项目状态：
已结题

项目摘要

We encountered 9 patients with Kawasaki disease with ischemic findings on exercise stress tests, but without a stenotic lesions on coronary arteriography. 8 out of these 9 patients had a reduced coronary flow reserve due to reduced dilatory capacity of the small coronary arteries that are not visualized by coronary arteriography.To clarify the pathogenesis of reduced coronary flow reserve in Kawasaki disease, in this research, we examined ultrastructually the myocardial lesions and coronary bed in 8 patients with reduced coronary flow reserve described above, in comparison with 6 patients without reduced coronary reserve. The duration of illness is from 4 months to 15 years. All patients are still alive, but the persistent damages of myocardium and vasculature are found even after 15 years. Ultrastructurally, the myocardial changes are non-specific, showing hypertrophy and degeneration with bizarre nuclei, disarranged myofibrils and aggregative mitochondria with abnormalities. The vascular lesions included microaneurysm formation, endothelial cell projection and necrosis, and platelet thrombosis in both capillary and arteriole. Interstitial edema and fibrosis are also encountered.In this study, we emphasized that the vascular lesions have a progressive potential danger, which are one of the important factors induced the reduced coronary flow reserve and the persistent myocardial lesions in Kawasaki disease, though there is no active inflammation or other evidence seen in active phase of this disease.

我们遇到了9例川崎病患者，在运动负荷试验中发现缺血，但在冠状动脉造影术中没有狭窄病变。为了阐明川崎病冠脉血流储备减少的发病机制，我们对上述8例冠脉血流储备减少患者的心肌病变和冠脉床进行了超微结构观察，并与6例无冠脉储备减少的患者进行了比较。病程从4个月到15年不等。所有患者都还活着，但即使在15年后也发现了持续性的心肌和血管损害。在超微结构上，心肌的改变是非特异性的，表现为细胞核肥大和变性，核稀疏，肌原纤维排列紊乱，线粒体聚集异常。血管病变包括微动脉瘤形成，内皮细胞突起和坏死，毛细血管和微动脉内的血小板血栓形成。在这项研究中，我们强调血管病变具有进行性的潜在危险，这是导致川崎病冠状动脉血流储备减少和持续性心肌损害的重要因素之一，尽管在该病活动期没有活动性炎症或其他证据。