儿童川崎病心血管并发症的发病机制、诊断与临床管理研究进展

Research Progress on the Pathogenesis, Diagnosis and Clinical Management of Cardiovascular Complications in Children with Kawasaki Disease

摘要: 川崎病是一种急性系统性血管炎综合征，其病因及发病机制尚不明确，好发于5岁以下婴幼儿，现已成为全球导致儿童后天性心脏病最常见的病因之一。心血管系统是川崎病最主要的受累靶器官，并发症主要包括冠状动脉扩张、冠状动脉瘤、心肌炎、心包炎、心功能不全及瓣膜损害等，其中冠状动脉病变是造成患儿急性期死亡及远期心血管不良事件的最主要原因。近些年来，临床诊疗水平的逐渐提升与影像学技术的不断发展，川崎病心血管并发症的早期识别、危险分层与综合管理策略不断更新。本文就儿童川崎病心血管并发症的流行病学特征、发病机制、诊断评估方法、急性期与远期治疗管理、预后及研究展望等方面进行系统综述，为临床医师提供规范化、精准化的诊疗参考，进一步改善川崎病患儿的长期预后。

Abstract: Kawasaki disease (KD) is an acute systemic vasculitis syndrome with an incompletely clarified etiology, which is more common in infants and young children under 5 years old. Its incidence is on the rise globally, and it has become one of the most common causes of acquired heart disease in children worldwide. The cardiovascular system is the main target organ involved in Kawasaki disease, with a wide spectrum of complications, mainly including coronary artery dilatation, coronary artery aneurysm, myocarditis, pericarditis, cardiac insufficiency, and cardiac valve damage. Among them, coronary artery lesions (CALs) are the core cause of acute death and long-term adverse cardiovascular events in children, and also the key and difficult point in clinical diagnosis, treatment and long-term management. In recent years, with the continuous improvement of clinical diagnosis and treatment level and the iterative development of imaging evaluation technologies (such as high-resolution echocardiography, coronary computed tomography angiography, cardiac magnetic resonance imaging, etc.), the accuracy of early identification, the refinement of risk stratification and the comprehensive management strategies of cardiovascular complications of Kawasaki disease have been significantly optimized. Based on the latest domestic and foreign research progress, this article systematically reviews the epidemiological characteristics, pathogenesis, diagnostic and evaluation methods, acute and long-term treatment and management, prognosis and research prospects of cardiovascular complications of Kawasaki disease in children, aiming to provide standardized and precise diagnosis and treatment ideas and reference basis for clinicians, further optimize the diagnosis and treatment process, and improve the long-term cardiovascular prognosis of children with Kawasaki disease.