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Register a new userCardiac Involvement and Risk Factors in Kawasaki Disease
الاختلاطات القلبية في داء كاوازاكي، عوامل الخطورة، الإنذار
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سمير سرور( باحث )
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خلفية البحث و هدفه: داء كاوازاكي عبارة عن التهاب أوعية معمم مجهول السبب يؤدي إلى إصابة في الشرايين الإكليلية عند 20-25 % من الأطفال غير المعالجين. تكمن أهمية هذا البحث في إيجاد الطرائق اللازمة لاستقراء المرضى ذوي الخطورة العالية، و من ثم اتخاذ التدابير اللازمة من أجل الإقلال من المراضة و معدل الوفيات من خلال تحديد نمط الإصابات الإكليلية و تطورها و علاقتها بعوامل الخطورة. مواد البحث و طرائقه: درِس 70 طفلاً تحققت لديهم المعايير التشخيصية لداء كاوازاكي، راوحت أعمارهم بين 3 شهور و 10 سنوات، شكل الذكور نحو ثلثي الحالات. النتائج: بلغ عدد الإصابات الشريانية الإكليلية 15 حالة بنسبة 21.4 %، شَكَّل التهاب التأمور 17 % إِذ وجد لدى 12 حالة، في حين لوحظ القصور التاجي في 7 حالات فقط بنسبة 10 %. صنفت الإصابة الإكليلية إلى: التوسع العابر ( 5 ) حالات ( 33.3 %)، أمهات الدم 10 حالات ( 66.6 %). توزعت أمهات الدم الإكليلية وفقاً لقياس القطر الداخلي إلى أمهات الدم الصغيرة – المتوسطة ( 6) حالات، أمهات الدم الكبيرة ( 2) حالة، أمهات الدم العرطلة ( 2) حالة. أما عوامل الخطورة فكانت: العمر دون السنة و أكثر من 5 سنوات، و الجنس الذكري، و حمى أكثر من عشرة أيام أو عودتها بعد مدة من زوالها، و انخفاض خضاب الدم، و انخفاض تعداد الصفيحات الدموية، و ارتفاع تعداد الكريات البيض و العدلات، و انخفاض البومين المصل، و التهاب التأمور. جرت المتابعة بتصوير صدى القلب إِذ لوحظ تراجع أمهات الدم بشكل عفوي في نحو 60 %من الحالات خلال مدة راوحت بين ( 5 -31 ) شهراً، اختفت الحالات الست من أمهات الدم الصغيرة- المتوسطة، كما شهدت حالتا أمهات الدم الكبيرة تراجعاً في حجمها، أما أمهات الدم العرطلة فقد احتاجت إحدى الحالات إلى عمل جراحي قلبي بسبب تطور تضيقات في الشرايين الإكليلية. الاستنتاج: سيطرت أمهات الدم الإكليلية على الإصابات القلبية في هذه الدراسة، كما لوحظ تراجع معظم أمهات الدم بشكل عفوي خلال مدة المتابعة.
Background& Objective: Kawasaki disease is a generalized vasculitis of unknown etiology which causes coronary artery abnormalities in 20-25 percent of untreated children. The aim of this study was to determine the type of heart lesion and the coronary risk factors and to identify patients with high risk in order to take the necessary measures to reduces morbidity and morbidity. Materials & Methods: We studied 70 children, aged 3 month to 10 years, who met the criteria for the diagnosis of KD, two thirds were males. Results: Of the (70) children who had KD , 15 cases (21.4 %) had coronary artery abnormalities ,12 cases (17 %) had pericarditis, and 7 cases (10 %) had mitral regurgitation .The coronary artery abnormalities were classified as follows: diffuse ectasia (5) cases 33.3%, coronary artery aneurysms 10 cases (66.6%). small to medium-sized coronary artery aneurysms (6) cases, large sized coronary artery aneurysms (2) cases, and giant aneurysms in (2) cases . The risk factors for coronary aneurysms were age less than 1 year or more than 5 years, male gender, fever lasting more than 10 days or recurrence of fever after an a febrile period, lower hemoglobin, lower platelet count, higher white cell count , lower albumin level and pericarditis. Echocardiogram follow up studied indicate coronary artery aneurysms resolve within 5 to 31 months in approximately 60% of patients where (6) aneurysms regressed spontaneously and the two large aneurysms became smaller. One patient with giant aneurysm had developed coronary stenosis and needed a coronary bypass surgery at the age of 9 years. Conclusion: Coronary aneurysms were the predominant cardiac lesions in our series, most of these aneurysms were resolved at follow up of 2-3 years.
References used
Rosenfeld EA, Corydon KE, Shulman ST. Kawasaki disease in infants less than one year of age. J Pediatr. 1995; 126: 524–529
Baer AZ, Rubin LG, Shapiro CA, Sood SK, Rajan S, Shapir Y. Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome. Arch Pediatr Adolesc Med. 2006; 160: 686–690
Tse SM, Silverman ED, McCrindle BW, Yeung RS. Early treatment with intravenous immunoglobulin in patients with Kawasaki disease. J Pediatr. 2002; 140: 450–455
Sawaji Y, Haneda N, Yamaguchi S, Kajino Y, Kishida K, Seto S, Konishi N,. Coronary risk factors in acute Kawasaki disease: correlation of serum immunoglobulin levels with coronary complications. Acta Paediatr Jpn. 1998; 40: 218–225
Brian W. McCrindle, MD, MPH; Jennifer S. Li, MD; L. LuAnn Minich, MD; Coronary Artery Involvement in Children With Kawasaki Disease Risk Factors From Analysis of Serial Normalized Measurements Circulation. 2007; 116: 174-179
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address this matter, we studied 65 patients had lacunar infarction at Depa
rtment of
Neurology , Tishreen University Hospital , Lattakia , Syria , and 65 controls during the
period between May 2017 – May 2018 .
Methods: We obtained information concerning risk factor exposure status among the
patients by a structured questionnaire , we recorded age , sex , blood pressure , glucose ,
heart diseases , cigarette smoking , alcohol drinking , physical exercise for patiens and
controls .We do laboratory tests and ECG and echocardiography and CT brain or MRI .
Results: Significantly increasing the risk of lacunar stroke were hypertension
(P-value=0.0001) and (OR=9.9), Current smokers (P-value=0.002) and (OR=5.2), diabetes
(P-value=0.001) and (OR=5.3) , whereas frequent physical exercise was associated with a
significantly decreased risk) P-value=00001( and (OR=2.6). There was no risk of
lacunar stroke associated with heart disease (P-value=0.6) (OR=0.8) , high cholesterol (Pvalue=
1) and (OR=1) , alcohol drinking (P-value=0.7) and (OR=0.8).
Conclusions: Patients with hypertension or diabetes, current smokers, those who
have not heart disease, are at a higher risk of lacunar stroke, whereas those who undertake
regular physical exercise may be at lower risk.
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