vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i4.735vsp-309Research ArticleНЕПРЕРЫВНОЕ ПРОФЕССИОНАЛЬНОЕ ОБРАЗОВАНИЕPROFESSIONAL DEVELOPMENTСИНДРОМ КАВАСАКИ С ПОРАЖЕНИЕМ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ: ОТДАЛЕННЫЕ ПОСЛЕДСТВИЯKAWASAKI SYNDROME WITH INVOLVEMENT OF CARDIOVASCULAR SYSTEM: LONG-TERM CONSEQUENCESШиринскаяО. Г.ShirinskayaO. G.

Shirinskaya Ol’ga Grigor’evna, MD, doctor of the Department of Ultrasonic Diagnosis of University Child Clinical Hospital of I.M. Sechenov First Moscow State Medical University

olga-shirinsky125252@yandex.ruЛыскинаГ. А.LyskinaG. A.olga-shirinsky125252@yandex.ruБокерияО. Л.BokeriyaO. L.olga-shirinsky125252@yandex.ruГагаринаН. В.GagarinaN. V.olga-shirinsky125252@yandex.ruЛеонтьеваА. А.Leont’evaA. A.olga-shirinsky125252@yandex.ruСатюковаА. С.SatyukovaA. S.olga-shirinsky125252@yandex.ruПервый Московский государственный медицинский университет им. И.М. СеченоваРоссияI.M. Sechenov first Moscow State Medical UniversityRussian FederationНаучный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН, МоскваРоссияBakoulev Center for Cardiovascular Surgery of RAMS, MoscowRussian Federation201312072013124Вопросы современной педиатрии92103Copyright © Ширинская О.Г., Лыскина Г.А., Бокерия О.Л., Гагарина Н.В., Леонтьева А.А., Сатюкова А.С., 20132013Ширинская О.Г., Лыскина Г.А., Бокерия О.Л., Гагарина Н.В., Леонтьева А.А., Сатюкова А.С.Shirinskaya O.G., Lyskina G.A., Bokeriya O.L., Gagarina N.V., Leont’eva A.A., Satyukova A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/309

Синдром Кавасаки — острый системный васкулит неизвестной этиологии, встречающийся преимущественно у детей первых 5 лет жизни, — может представлять серьезную угрозу для здоровья и жизни пациентов не только в остром периоде заболевания, но и спустя многие годы. Наибольшее значение для прогноза имеет поражение коронарных артерий с образованием аневризм и высоким риском последующего тромбоза и/или стеноза коронарных артерий, которые могут привести к ишемии/инфаркту миокарда и внезапной смерти лиц молодого возраста. В статье освещены варианты отсроченных патологических изменений коронарных артерий. Аневризмы исчезают в среднем в 50–60% пораженных сегментов коронарных артерий в течение первых 2 лет после перенесенного заболевания. Вероятность исчезновения аневризм зависит от их диаметра, формы, локализации и возраста пациента. Гигантские аневризмы представляют наибольшую угрозу развития коронарного тромбоза и стеноза. Клинические последствия коронарного тромбоза варьируют от бессимптомного течения до инфаркта миокарда в зависимости от размера тромба, его локализации и расположения в аневризме. Вероятность возникновения коронарного стеноза зависит от размеров аневризм и возрастает по мере увеличения периода времени, прошедшего от начала заболевания. Также приведена информация о диагностических возможностях инструментальных методов исследования коронарных артерий, тактика динамического наблюдения и лечения реконвалесцентов с целью снижения риска развития угрожающих жизни осложнений. Изложенный материал основан на обобщении данных литературы и собственного опыта наблюдения 90 пациентов с синдромом Кавасаки, заболевших в 2004–2010 гг.

Kawasaki syndrome is an acute systemic vasculitis with unknown etiology, affecting primary children at the age of 0–5 years old, which can be of a real threat for health and life not only during acute stage of the disease, but also many years after. The main prognostic factor is involvement of the coronary arteries with aneurisms development and high risk of consequent thrombosis and/or stenosis of the coronary arteries, which can lead to myocardial ischemia/infarction and sudden death syndrome in young patients. Different variants of long-term pathological changes of the coronary arteries are discussed in the article. Aneurisms regressed in 50–60% of involved segments of the coronary arteries within first 2 years after active stage. The probability of regression of aneurisms depends on their diameter, form, localization and patient’s age. Gigantic sizes of aneurisms have the highest risk of coronary thrombosis and stenosis. Clinical consequences of coronary thrombosis vary from asymptomatic course to myocardial infarction, depending on thrombus size and localization. The risk of coronary stenosis depends on aneurism size and increases with time passed from the onset of the disease. The authors give information on diagnostic possibilities of instrumental methods of investigation of the coronary arteries, management of follow-up and treatment of reconvalescents in order to decrease risk of life-threatening conditions. The shown data are based on the literature review and own experience of observation of 90 patients with Kawasaki syndrome with the onset of the disease between 2004 and 2010 years.

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The authors declare that there are no conflicts of interest present.