儿童川崎病严重冠状动脉病变合并心肌梗死41例分析  

Analysis of 41 cases of myocardial infarction in children with coronary artery lesion after Kawasaki disease

作　　者：吕爱婷 叶岚 储晨 何岚 赵趣鸣 赵璐 王凤 林怡翔 孙淑娜 黄国英 刘芳 Lyu Aiting;Ye Lan;Chu Chen;He Lan;Zhao Quming;Zhao Lu;Wang Feng;Lin Yixiang;Sun Shuna;Huang Guoying;Liu Fang(Pediatric Heart Center,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai,201102 China)

机构地区：[1]国家儿童医学中心、复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中华儿科杂志》2025年第2期157-162,共6页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(82070513,82100524)。

摘　　要：目的分析川崎病合并严重冠状动脉病变(CAL)患儿发生心肌梗死的临床特征及诊治特点。方法回顾性分析2017年1月至2024年8月在复旦大学附属儿科医院住院的41例川崎病合并心肌梗死患儿的临床资料,包括一般特征、川崎病以及CAL的诊疗过程、心肌梗死发生时的临床表现、心电图及影像学检查结果、治疗及结局。结果(1)人口学特征:41例患儿中男36例、女5例,心肌梗死发病年龄为4.6(2.3,5.7)岁,心肌梗死距川崎病起病的时间为397(50,1095)d。(2)川崎病急性期诊治:仅15例(37%)患儿在病程10 d内接受2 g/kg静脉注射免疫球蛋白的标准初始化治疗,其余26例(63%)均为不规范治疗或未治疗。(3)心肌梗死前CAL的诊治:诊断CAL距川崎病发病时间为14(10,116)d,其中15例出现心肌梗死时才发现CAL。26例心肌梗死发生前已诊断CAL的患儿,9例仅给予抗血小板治疗,其中7例应用双嘧达莫口服;16例给予抗血小板联合华法林治疗,仅1例INR达到目标值1.5~2.5。41例患儿中规范抗血栓治疗仅1例(2%)。(4)心肌梗死临床表现:32例患儿发生心肌梗死时表现为不同程度的临床症状,其中18例为胸闷、胸痛、心前区不适等,10例出现呼吸及心搏骤停伴晕厥或抽搐,其他为腹痛、恶心、呕吐、精神差等非特异性症状;9例无症状患儿常规复查时发现静默性心肌梗死。(5)心肌梗死心电图和影像学表现:心电图检查33例有ST-T改变,其他包括异常Q波、心律失常;超声心动图显示CAL合并血栓27例,左心室射血分数下降18例,室壁运动异常15例,室壁瘤3例;37例进行了冠状动脉造影和(或)冠状动脉多层螺旋CT血管成像,其中闭塞血管39支,重度狭窄(≥75%)血管3支,均为巨大冠状动脉瘤合并血栓形成导致。(6)心肌梗死治疗:32例急性心肌梗死患儿9例行心肺复苏均成功,7例给予静脉溶栓治疗,1例进行经皮冠状动脉球囊成形术,之后均给予双抗血小板及治Objective To analyze the clinical characteristics,diagnosis and treatment of pediatric myocardial infarction(MI)patients with coronary artery lesions(CAL)after Kawasaki disease(KD).Methods Clinical data including baseline characteristics,KD and CAL information,clinical symptoms at MI onset,electrocardiogram(ECG)and imaging findings,MI treatment,and clinical outcomes of 41 MI patients with CAL after KD admitted to the Children′s Hospital of Fudan University from January 2017 to August 2024 were analyzed retrospectively.Results(1)Demographic characteristics:a total of 41 patients were included(36 males and 5 females).The age at MI was 4.6(2.3,5.7)years,and time from KD onset to MI was 397(50,1095)d.(2)Treatment of acute KD:only 15 patients(37%)received standard initial treatment within 10 days of KD onset with intravenous immunoglobulin 2 g/kg.The other 26 cases(63%)received non-standard treatment or no treatment.(3)Treatment of CAL before MI:the time from KD onset to CAL was 14(10,116)d,with CAL not identified before MI onset in 15 patients.Among the 26 cases diagnosed with CAL prior to MI,9 cases received only single or dual antiplatelet drug,of which 7 cases received oral dipyridamole.The remaining 16 cases received antiplatelet drug combined with warfarin,but only 1 case achieved the target international standardized ratio of 1.5-2.5.Out of all 41 cases,only 1 case(2%)received standard antithrombotic treatment before MI onset.(4)Clinical symptoms of MI:at MI onset,32 patients presented with different clinical symptoms,with typical MI symptoms such as chest tightness,chest pain,precordial discomfort in 18 cases,and cardiopulmonary arrest accompanied by syncope or convulsions in 10 cases.Other non-specific symptoms included abdominal pain,nausea,vomiting and pallor.Nine patients were asymptomatic and were found to have silent MI on follow-up.(5)ECG and imaging findings:ECG showed ST-T changes in 33 cases,and abnormal Q waves,and arrhythmias in the remaining patients;echocardiography indicated coronary artery an

关 键 词：冠状动脉疾病 心肌梗死 回顾性研究 儿童 

分 类 号：R725.4[医药卫生—儿科]