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

大多数川崎患者康复后不会留下心血管后遗症。然而，即使在这些KD患者中，冠状动脉（CA）也存在血管炎瘢痕。无动脉瘤但仍有血管瘤疤痕的动脉的预后尚未明确。我们对远期死亡的KD尸检患者的无动脉瘤CA进行了病理学研究。材料与方法：本研究对7例发病后40天以上死亡的KD尸检患者进行了检查。死亡年龄1 ~ 15岁。分别行H&E、EvG、AM、Al-B染色，观察动脉组织学变化，特别是内膜成分。此外，还使用了针对细胞生长因子（GF）和平滑肌细胞（SMC）表型的抗体。对这些抗体的反应性，在冠状动脉内膜中的KD患者与对照尸检patients.Results：的变化，它被假定为血管炎已存在于急性期被确认在冠状动脉的5个KD患者。2例KD患者有非常轻微的内膜增厚，与对照组相比无明显差异。在发病后1年内死亡的患者CA上，PDGF、VEGF等GFs对内皮细胞和SMC呈阳性表达，内膜SMC呈去分化表型。而在发病后1年或1年以上死亡的患者，其冠状动脉GF和SMC表型的阳性模式与对照组相似。然而，当管腔正常化时，动脉的特征变得与对照患者的特征相似。这些动脉似乎不会在未来推进到狭窄病变。

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.