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中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (06) : 621 -626. doi: 10.3877/cma.j.issn.1673-5250.2020.06.001

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川崎病患儿冠状动脉微循环功能评估及其临床应用研究现状
周忠琴1, 文凌仪1, 郭应坤1,†()   
  1. 1. 四川大学华西第二医院放射科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
  • 收稿日期:2020-04-03 修回日期:2020-10-12 出版日期:2020-12-01
  • 通信作者: 郭应坤

Current status of evaluation and clinical application research on coronary microcirculation dysfunction in children with Kawasaki disease

Zhongqin Zhou1, Lingyi Wen1, Yingkun Guo1,†()   

  1. 1. Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2020-04-03 Revised:2020-10-12 Published:2020-12-01
  • Corresponding author: Yingkun Guo
  • Supported by:
    National Natural Science Foundation of China(81771897, 81971586); Chengdu Key Research and Development Support Program Project(2018-YFYF-00017-SN)
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周忠琴, 文凌仪, 郭应坤. 川崎病患儿冠状动脉微循环功能评估及其临床应用研究现状[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(06): 621-626.

Zhongqin Zhou, Lingyi Wen, Yingkun Guo. Current status of evaluation and clinical application research on coronary microcirculation dysfunction in children with Kawasaki disease[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(06): 621-626.

川崎病(Kawasaki disease)是一种以急性全身血管炎为主要病理改变的疾病，好发于年龄<5岁婴幼儿，是婴幼儿获得性冠状动脉疾病最常见病因。川崎病导致的心血管疾病并发症，严重影响患儿预后。近年川崎病所致患儿冠状动脉微循环功能障碍，逐渐引起重视。冠状动脉内多普勒(ICD)、经胸超声心动图(TTE)、正电子发射计算机断层显像(PET)、单光子发射计算机断层显像(SPECT)及心血管MRI(CMR)等影像学技术，均可定量监测川崎病患儿冠状动脉血流储备(CFR)和微循环系统功能异常，但是监测效果各有优、缺点。笔者拟就冠状动脉微循环功能障碍的发生机制及其影像学诊断技术的最新研究进展、临床应用等进行阐述，旨在为川崎病患儿冠状动脉微循环功能障碍的临床精准量化、长期监测和预后评价提供帮助。

关键词: 黏膜皮肤淋巴结综合征, 心肌灌注显像, 冠状动脉疾病, 微循环, 放射摄影影像解释, 计算机辅助, 冠状动脉微循环功能障碍, 冠状动脉血流储备, 儿童

Kawasaki disease is an acute systemic vasculitis, which predominantly occurs in children<5 years old. Kawasaki disease is leading cause of acquired coronary artery diseases in children, and its cardiovascular complications affect prognosis of patients. In recent years, coronary microcirculation dysfunction caused by Kawasaki disease has aroused a lot of research concern and clinical attention. Some imaging modalities can sensitively detect and quantitatively measure coronary flow reserve (CFR) and microcirculation dysfunction in children with Kawasaki disease, including intracoronary Doppler (ICD), transthoracic echocardiography (TTE), positron emission computed tomography (PET), single-proton emission computed tomography (SPECT), and cardiovascular magnetic resonance (CMR). However, each method has its advantages and limitations. This paper reviews latest research progresses in mechanism of coronary microcirculation dysfunction and their diagnostic imaging technology and clinical application, aiming to improve accurate quantification, long-term monitoring and prognosis evaluation of coronary microcirculation dysfunction in children with Kawasaki disease.

Key words: Mucocutaneous lymph node syndrome, Myocardial perfusion imaging, Coronary artery disease, Microcirculation, Radiographic image interpretation, computer-assisted, Coronary microcirculation dysfunction, Coronary flow reserve, Child
表1 对川崎病患儿冠状动脉微循环功能的影像学评价方法比较
影像学评价技术 无创性检查技术 测量参数 量化指标 优点 局限性
ICD 否 APV CFR 精准 技术复杂、有创性检查
TTE 是 DPV CFR 经济、易于对患儿随访 对冠状动脉显示效果较差
PET 是 MBF MFR 精准、图像分辨率高于SPECT 费用昂贵、基层医院普及率低
SPECT 是 MBF MFR 基层医院普及率高于PET 耗时长、图像分辨率低
CMR 是 RU/MBF MPRI/MFR 精准、无电离辐射、分辨率高 对患儿配合度要求较高
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