Comparative study on Kawasaki disease between Japan and North America

本项目的目的是调查日本和美国在川崎病的流行病学、病理生理学和治疗方面的比较评估。在流行病学方面，柳川展示了日本全国范围内的调查结果，特别是患者人口的转变、心脏后遗症、死亡率、复发率和兄弟姐妹病例的发生率。舒尔曼和他的同事评估了急性期血管组织中IgA浆细胞的病理生理学作用。Newberger和他的同事建议，在川崎病患者中，超声心动图评估的冠状动脉尺寸可能被错误地归类为正常。虽然日本厚生劳动省的标准只公布了明确界定本病冠状动脉异常的标准，但已有研究表明，正常儿童的冠状动脉内径与身体大小指数(如体表面积或体长)呈线性增长。他们引入了…更多的体表面积数据修正了冠状动脉的内径。在治疗领域，Takahashi和他的同事介绍了小剂量韦尔法林加阿司匹林治疗合并巨大冠状动脉瘤的患者，这会导致心肌梗死。关于如何治疗那些抵抗最初的丙种球蛋白治疗的患者，一直存在争议。加藤和他的同事展示了类固醇脉冲疗法在这类患者中的临床试验。他们目前的研究结果表明，类固醇冲击疗法和丙种球蛋白疗法的冠状动脉病变发生率没有差异，但类固醇脉冲疗法的医疗费用往往较低。应该在这方面进行进一步的调查。其他治疗主题与冠状动脉受累及其长期结果有关。日本全国导管介入调查结果报告了导管介入作为一种新的治疗策略的重要性。Kato和他的同事报告说，使用直接注射乙酰胆碱的方法，冠状动脉动脉瘤部位存在内皮功能障碍。较少

The objective of this project was to investigate of comparative evaluation between Japan and United States in terms of epidemiology, pathophysiology and treatment of Kawasaki disease. In the area of epidemiology, Yanagawa demonstrated the result of Japanese nationwide survey, especially the transition of patient's population, cardiac sequelae, mortality, recurrent rate and incidence of sibling case. Pathophysiological role of IgA plasma cells in vascular tissue during the acute stage was evaluated by Shulman and colleagues. Newberger and colleagues suggested that coronary arterial dimensions evaluated by echocardiography might be misclassified as normal in Kawasaki disease. Although the criteria of Japanese Ministry of Health is only published criteria the specifically define coronary artery abnormality in this disease, coronary artery dimensions in normal children have been shown to increase linearly with indices of body size, such as body surface area or body length. They introduced … More the data of body surfacarea corrected coronary dimensions. In the therapeutic area, Takahashi and colleagues introduced of low-dose wairfarin plus aspirin therapy in patients complicated with giant coronary aneurysm, which cause of myocardial infarction. Controversy has been persisted how to treat the patients who resisted initial gamma globulin treatment. Kato and colleagues demonstrated the clinical trail of steroid pulse therapy in such patients. Their current results shown the incidence of coronary artery lesion was not different between steroid pulse and gamma globulin therapy, however medical cost of steroid pulse therapy tend to be lower. Further investigation in this area should be required. Other topics of treatment were relatedof coronary artery involvements and its long-term outcome. Result of Japanese nationwide survey of catheter intervention was reported their importance as a new therapeutic strategies. Kato and colleagues reported that the presence of endothelial dysfunction at the site of regressed coronary aneurysm using direct infusion of aceylcholine. Less