Histopathological study on the non-aneurysmal coronary arteries in the remote period of Kawasaki disease.

大多数川崎病(KD)患者在不留下心血管后遗症的情况下康复。然而，即使在这些KD患者中，冠状动脉(CA)也存在血管炎的疤痕。虽然没有动脉瘤，但仍留有心绞痛疤痕的动脉的预后尚不清楚。我们对远期死亡的KD尸检患者的无动脉瘤的CA进行了病理学研究。材料和方法：本研究对7例发病40天以上死亡的KD尸检患者进行了检查。患者死亡年龄从1岁到15岁不等。进行H&E、EVG、AM和Al-B染色，观察动脉的组织学变化，尤其是内膜的成分。此外，还使用了抗细胞生长因子(GFS)和平滑肌细胞(SMC)表型的抗体。结果：7例KD患者中有5例冠状动脉内膜出现了推测为血管炎的改变。2例KD患者有轻微的内膜增厚，与对照组相比差异无统计学意义。在发病1年内死亡的患者CA中，血管内皮细胞和血管内膜细胞呈PDGF和VEGF阳性，血管内膜细胞呈去分化表型。而在KD发病后1年以上死亡的患者的冠状动脉中，GFS和SMC表型的阳性模式与对照组相似。结论：KD患者非动脉瘤样冠脉中仍有血管炎疤痕。然而，当管腔恢复正常时，动脉的特征变得与对照组患者相似。这些动脉在未来似乎不会进展到狭窄的病变。

The majority of Kawasaki disease (KD) patients recover without leaving the cardiovascular sequelae. However, the scar of vasculitis exists in the coronary artery (CA) even in these KD patients. The prognosis of the artery that remains the scar of angitiis though there is no aneurysm has not been clarified yet. We performed a pathological study on the CAs without aneurysms of the KD autopsy patients who died during remote period.Materials and Methods : Seven KD autopsy patients who had died over 40 days after the onset of illness were examined in this study. The age when patients died ranged from 1 to 15 years old. H&E, EvG, AM and Al-B stains were performed and we observed histology of the arteries, especially the component of the intima. In addition, the antibodies against the cellular growth factors (GFs) and the smooth muscle cell (SMC) phenotypes were used. The reactivity against these antibodies in the intima of CA in KD patients was compared with those of control autopsy patients.Results : The changes to which it was presumed that vasculitis had existed in the acute stage was recognized in the coronary arteries of five of seven KD patients. Two KD patients had the very slight intimal thickenings which were unremarkable compared with the control patients. On the CAs of the patients who had died within one year from the onset of KD, GFs such as PDGF and VEGF were positive for the endothelial cells and the SMCs, and the intimal SMCs showed the dedifferentiation phenotype. However, as for the coronary arteries of the patients who had died one year or more after the KD onset, the pattern of positivity of the GFs and the SMC phenotypes became similar to those of the controls.Conclusion : The scar of vasculitis remains in the non-aneurysmal coronary arteries of KD patients. However, when the lumen normalizes, the characteristics of the arteries become similar to those of the control patients. These arteries seem not to advance to the stenotic lesions in the future.