川崎病的诊治进展及其心血管并发症

1、川崎病的诊治进展及其心血管并发症2004 Dec. Beijing60多个国家报道川崎病发生世界1/3的国家报道有川崎病 Nakamura Y, Yanagawa H. Prog Ped Cardiol, 2004,19:99108 研究者研究者地区地区调查年限调查年限发病率发病率调查方法调查方法Holman全国全国2000199717.117.6全国儿童住院病人数据库全国儿童住院病人数据库Chang 加州加州1995-199915.3州住院系统数据库州住院系统数据库Gibbons佐治亚州佐治亚州1997-199814.0住院病历调查住院病历调查BronsteinSan Diego1994-1

2、9988.0-15.4住院病历调查住院病历调查Holman全国全国199717.3全国儿童住院系统数据库全国儿童住院系统数据库Holman夏威夷州夏威夷州康乃迪克州康乃迪克州1994-19971993-199647.718.8各州住院系统数据库各州住院系统数据库Belay 西海岸四州西海岸四州 1993-19969.0-19.1 保险公司住院系统数据库保险公司住院系统数据库Holman阿拉斯加州阿拉斯加州1980-19954.8阿拉斯加美国印第安医疗系统阿拉斯加美国印第安医疗系统Taubert美国美国33个州个州1984-19939.87住院病历调查住院病历调查Davis西雅图地区西雅图地区1

3、987-198915.2住院病历调查住院病历调查010203040506070801995 1996 1997 1998 1999 2000 2001 2002 2003 2004YearIncidence (/100000 children5year)BoysGirlsTotalDu Zhong-Dong, et al. Pediatr Infect Dis J. 2002,21(2):103107体表面积校正的冠脉正常内径体表面积校正的冠脉正常内径( (Zorzi)左冠体表面积2.01.51.0.50.05.04.54.03.53.02.52.01.51.0ObservedLinearQu

4、adratic右冠体表面积2.01.51.0.50.04.03.53.02.52.01.51.0ObservedLinearQuadratic前降体表面积2.01.51.0.50.04.03.53.02.52.01.51.0.5ObservedLinearQuadratic回旋体表面积2.01.51.0.50.04.03.53.02.52.01.51.0.5ObservedLinearQuadraticEchocardiogram of coronary 0510152025198284868890929496982000Year% %MalesFemales杜忠东，贾立群，张永兰等。中华儿科

5、杂志, 2007;45(5):395-396. 18 x 9 x 11 mm 川崎病体循川崎病体循环环瘤瘤Axillary A. rt.18 lt.17Co. iliac A.rt.16 lt.15Int. iliac A. rt. 12 lt.11Renal A.6Mesent. A.2ITArt.2lt.2Aorta1Digital gangrene0主主动动脉瓣反流脉瓣反流5（ （0.2）n心肌梗塞心肌梗塞24（ （1.2）n死亡死亡10（ （0.3）RCALCA第一次冠脉造影第一次冠脉造影(发发病病40 d)RCALCA第二次冠脉造影第二次冠脉造影 (发发病病6个月个月 2000.4

6、2000.12 2002.3冠脉狭窄及再通冠脉狭窄及再通VRVR显示显示RCARCA全程迂曲全程迂曲扩张，部扩张，部分呈串珠分呈串珠样改变，样改变，其中间插其中间插有狭窄段有狭窄段 MPRMPR显示显示RCARCA中段冠脉瘤，中段冠脉瘤，可见血栓和可见血栓和多发钙化灶多发钙化灶 Kato H, Akagi T, et al. Circulation 1996; 94: 13790 01010202030304040505060600 05 51010151520201 13 35 57 79 91111131315151717(years)Arterial graftVenous graftY

7、oshikawa, et al. Eur J Cardio Surg 2000Sugimura T, Kato H, Inoue O, et al. The Journal of Pediatrics 1992;121.684-8 Cheung YF, Wong SJ, Ho MH. Archives of Disease in Childhood 2007;92:43-7 Zhong-Dong Du, MD, PhDProfessor of PediatricsBeijing Childrens HospitalCapital Medical U60多个国家报道川崎病发生世界1/3的国家报道

8、有川崎病 Nakamura Y, Yanagawa H. Prog Ped Cardiol, 2004,19:99108 AuthorAreasStudy yearRatesStudy methodsHolmanAll states2000199717.117.6National in-pts data baseChang California1995-199915.3States in-pt data baseGibbonsGeorgia1997-199814.0SurveyBronsteinSan Diego1994-19988.0-15.4SurveyHolmanAll states19

9、9717.3Kids in-pt data baseHolmanHI, CO1994-19971993-199647.718.8States in-pt data basesBelay West costal 1993-19969.0-19.1 Data base of health insuranceHolmanAlaska1980-19954.8Data base Taubert33 states1984-19939.87In-pt chart surveyDavisSeatle1987-198915.2In-pa chart surveyDu Zhong-Dong, et al. Ped

10、iatr Infect Dis J. 2002,21(2):103107010203040506070801995 1996 1997 1998 1999 2000 2001 2002 2003 2004YearIncidence (/100000 children5year)BoysGirlsTotalNormal Coronary Artery Diameter corrected by BSA (Zorzi)左冠体表面积2.01.51.0.50.05.04.54.03.53.02.52.01.51.0ObservedLinearQuadratic右冠体表面积2.01.51.0.50.04

11、.03.53.02.52.01.51.0ObservedLinearQuadratic前降体表面积2.01.51.0.50.04.03.53.02.52.01.51.0.5ObservedLinearQuadratic回旋体表面积2.01.51.0.50.04.03.53.02.52.01.51.0.5ObservedLinearQuadraticLCA LCX LADRCA Echocardiogram of coronary 0510152025198284868890929496982000Year% %MalesFemales18 x 9 x 11 mm Systemic Artery

12、 AneurysmsAxillary A. rt.18 lt.17Co. iliac A.rt.16 lt.15Int. iliac A. rt. 12 lt.11Renal A.6Mesent. A.2ITArt.2lt.2Aorta1Digital gangrene0Aortic insufficiency5（ （0.2）nMyocardial infarction24（ （1.2）nFatal cases10（ （0.3）RCALCA1st Angiography (40 days after the onset)RCALCA2nd Angiography (6 months after the onset) 2000.4 2000.12 2002.3Coronary artery obstruction and recanalizationRCA in VRRCA in VRRCA in MPRRCA in MPRKato H, Akagi T, et al. Circulation 1996; 94: 13790 01010202030304040505060600 05 51010151520201 13 35 57 79 91111131315151717(years)Arterial graftVeno