[川崎病引起的冠状动脉闭塞 Coronary Artery Occlusion from Kawasaki’s Disease]

【译文】一名18岁的男子因急性胸痛急诊就诊。11岁时被诊断为川崎病。尽管使用静脉注射免疫球蛋白治疗,但影像学检查发现冠状动脉瘤。就诊时,他服用的药物包括阿司匹林和华法林。心电图胸前导联V1至V3 ST段抬高。紧急冠状动脉造影显示左前降支闭塞。川崎病是一种急性、特发性、自限性血管炎,主要影响儿童。临床表现包括发热、双眼非渗出性结膜炎、粘膜炎、颈淋巴结肿大、多形性皮疹和手足改变。并非所有这些临床表现都出现,而且没有针对川崎病特异性的诊断方法。所以儿童期可能未做出该病诊断,或幼年时患病成年后忘记这段经历。患儿童有心血管并发症的风险。该患者接受了冠状动脉搭桥手术。治疗后3年的随访中,他的身体状态良好并且没有新的并发症出现。

【原文】 An 18-year-old man presented to the emergency department with chest pain. He had a history of Kawasaki’s disease, which had been diagnosed when he was 11 years of age. Despite treatment with intravenous immune globulin, coronary artery aneurysms were detected on imaging. At the time of the current presentation, his medications included aspirin and warfarin. An electrocardiogram showed ST-segment elevations in leads V1 to V3. Emergency coronary angiography revealed occlusion of the left anterior descending artery. Kawasaki’s disease is an acute, idiopathic, self-limiting vasculitis that primarily affects children. Clinical features include fever, nonexudative conjunctivitis in both eyes, mucositis, cervical lymphadenopathy, polymorphous rash, and changes in the hands and feet. Because not all these features are necessarily present and there is no specific diagnostic test for Kawasaki’s disease, the diagnosis may be missed in childhood or occur at such an early age that the adult patient has no recollection of illness. Affected children are at risk for cardiovascular complications. The patient underwent coronary artery bypass surgery. At follow-up 3 years after presentation, he was doing well and had no further cardiac symptoms.