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目的探讨川崎病(KD)患儿脑血流变化特点。方法收集2007年1月-2010年12月本院确诊为KD的住院患儿52例,根据是否合并冠状动脉损害,将其分为冠状动脉受损组(n=27)和无冠状动脉受损组(n=25)。用经颅多普勒超声方法观察KD患儿脑血流异常率及脑血流参数变化。结果冠状动脉受损组患儿脑血流异常率较无冠状动脉受损组明显升高(55.6%vs12.0%,χ2=10.671,P=0.001)。脑血流参数主要表现:冠状动脉受损组右侧ACA Vm、PCA Vm值较无冠状动脉受损组显著减低[(59.15±13.23)cm.s-1 vs(68.20±18.59)cm.s-1,t=6.499,P=0.014;(59.00±9.62)cm.s-1 vs(67.71±4.48)cm.s-1,t=6.878,P=0.012)];双侧MCA的PI值(0.94±0.16 vs 0.87±0.69,t=6.709,P=0.013;0.97±0.14 vs 0.88±0.09,t=4.669,P=0.036)、左侧PCA的PI值(0.98±0.11 vs 0.96±0.06,t=7.166,P=0.010)均较无冠状动脉受损组显著升高。冠状动脉受损组神经系统症状发生率较无冠状动脉受损组显著升高(40.7%vs 8.0%,χ2=7.279,P=0.007)。结论合并冠状动脉损害的KD患儿易于出现脑血流异常。脑血流异常较敏感,有助于及早发现颅内动脉血管损害。
Objective To investigate the changes of cerebral blood flow in children with Kawasaki disease (KD). Methods Fifty-two hospitalized children with KD diagnosed in our hospital from January 2007 to December 2010 were divided into two groups according to whether they had coronary artery lesion or not: coronary artery impaired group (n = 27) and no coronary artery injury Group (n = 25). Transcranial Doppler echocardiography was used to observe the changes of cerebral blood flow anomalies and cerebral blood flow parameters in children with KD. Results The rate of abnormal cerebral blood flow in patients with coronary artery impaired group was significantly higher than that without coronary artery impaired group (55.6% vs 12.0%, χ2 = 10.671, P = 0.001). The main parameters of cerebral blood flow were as follows: the ACA Vm and PCA Vm in the right side of the coronary artery lesion were significantly lower than those in the non-coronary artery lesion [(59.15 ± 13.23) cm.s-1 vs (68.20 ± 18.59) cm.s- 1 (t = 6.499, P = 0.014; (59.00 ± 9.62) cm.s-1 vs (67.71 ± 4.48) cm.sup.-1, t = 6.878, P = 0.012) 0.97 ± 0.14 vs 0.88 ± 0.09, t = 4.669, P = 0.036). The PI of the left PCA (0.98 ± 0.11 vs 0.96 ± 0.06, t = 7.166 ± 0.18 vs 0.87 ± 0.69, t = 6.709, , P = 0.010) were significantly higher than those without coronary artery injury. The incidence of neurological symptoms in patients with coronary artery injury was significantly higher than those without coronary artery injury (40.7% vs 8.0%, χ2 = 7.279, P = 0.007). Conclusions KD children with coronary artery lesion are prone to cerebral blood flow abnormalities. Cerebral blood flow abnormalities more sensitive to help early detection of intracranial arterial vascular damage.