川崎病冠脉瘤患儿远期血管内皮功能的研究

段超; 杜忠东; 王玉; 贾立群

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中国当代儿科杂志 ›› 2011, Vol. 13 ›› Issue (5) : 373-376.

论著·临床研究

川崎病冠脉瘤患儿远期血管内皮功能的研究

段超，杜忠东，王玉，贾立群

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Late endothelial function in children with coronary aneurysm due to Kawasaki disease

DUAN Chao, DU Zhong-Dong, WANG Yu, JIA Li-Qun

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摘要

目的：评估川崎病（KD）冠脉瘤患儿远期血管内皮功能。方法：选择病程大于1年的合并中型以上冠脉瘤的川崎病患儿31例为研究对象，采用高分辨率超声仪进行肱动脉内皮依赖性和非依赖性舒张功能（FMD）、颈动脉僵硬度指数（SI）和颈动脉内中膜厚度（IMT）的检测。选择年龄相近的正常儿童21例作为对照。结果：31例KD冠脉瘤患儿中，中型冠脉瘤9例，冠脉巨大瘤22例，其中12例有心肌缺血。与对照组比较，KD冠脉瘤组患儿肱动脉血管内皮依赖性FMD减低（P＜0.05），颈动脉SI增加（P＜0.05），颈动脉IMT增厚（P＜0.05）。与无心肌缺血患儿相比，有心肌缺血患儿血管内皮依赖性FMD显著降低（P＜0.05）。结论：KD冠脉瘤患儿远期存在血管内皮功能障碍，且合并心肌缺血患儿的血管内皮功能障碍尤为显著。

Abstract

OBJECTIVE: To evaluate the late endothelial function in children with coronary aneurysm due to Kawasaki disease (KD). METHODS: Thirty-one children with coronary aneurysms due to KD who had the disease course for more than 1 year and twenty-one age-matched healthy children were enrolled. Brachial artery endothelium-dependent and -independent flow-mediated dilation (FMD), carotid arterial stiffness index (SI) and intima-media thickness (IMT) were measured by high-frequency ultrasound. RESULTS: There were 9 cases of medium and 22 cases of giant coronary aneurysms in the KD group. Twelve KD patients had evidence of myocardial ischemia. Compared to the normal controls, the endothelium-dependent FMD decreased (P<0.05), the carotid arterial SI increased (P<0.05), and the carotid arterial intima-media thickness increased significantly (P<0.05) in children with coronary aneurysms due to KD. The endothelium-dependent FMD decreased more significantly in 12 KD patients with myocardial ischemia than in those without any evidence of myocardial ischemia (P<0.05).ConclusionsLate endothelial dysfunction exists in children with coronary aneurysms due to KD, especially in those with myocardial ischemia.

导出引用

段超，杜忠东，王玉，贾立群. 川崎病冠脉瘤患儿远期血管内皮功能的研究[J]. 中国当代儿科杂志. 2011, 13(5): 373-376

DUAN Chao, DU Zhong-Dong, WANG Yu, JIA Li-Qun. Late endothelial function in children with coronary aneurysm due to Kawasaki disease[J]. Chinese Journal of Contemporary Pediatrics. 2011, 13(5): 373-376

中图分类号： R725

参考文献

［1］Du ZD, Zhao D, Du J, Zhang YL, Lin Y, Liu C, et al. Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004［J］. Pediatr Infect Dis J, 2007, 26(5): 449-451.

［2］段超，杜忠东. 63例川崎病合并冠状动脉瘤的中远期随诊［J］.中国实用儿科杂志, 2008, 24(1): 37-40.

［3］段超, 杜忠东, 张桂荣，万岁桂，孙雪静. 川崎病冠脉瘤远期血管改变与冠脉粥样硬化关系研究［J］. 中国实用儿科杂志, 2010, 25(10): 759-762.

［4］Stroes ES, Koomans HA, de Bruin TW,Rabelink TJ. Vascular function in the forearm of hypercholesterolaemic patients off and on lipid-lowering medication［J］. Lancet, 1995, 346(8973): 467-471.

［5］李宏亮, 余叶蓉, 蒲素, 喻红玲, 王椿, 张祥讯. 单纯性肥胖患者氧化应激与内皮依赖性血管舒张功能的关系［J］. 中国糖尿病杂志, 2008, 16(2): 97-100.

［6］Japaness Circulation Society Joint Research Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease［J］. Pediatr Int, 2005, 47(6): 711-732.

［7］Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association［J］. Pediatrics, 2004, 114(6): 1708-1733.

［8］Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis［J］. Lancet, 1992, 340(8828): 1111-1115.

［9］Ikemoto Y, Ogino H, Teraguchi M, Kobayashi Y. Evaluation of preclinical atherosclerosis by flow-mediated dilatation of the brachial artery and carotid artery analysis in patients with a history of Kawasaki disease［J］. Pediatr Cardiol, 2005, 26(6): 782-786.

［10］Kadono T, Sugiyama H, Hoshiai M, Osada M, Tan T, Naitoh A, et al. Endothelial function evaluated by flow-mediated dilatation in pediatric vascular disease［J］. Pediatr Cardiol, 2005, 26(4): 385-390.

［11］Silva AA, Maeno Y, Hashmi A, Smallhorn JF, Silverman ED, McCrindle BW. Cardiovascular risk factors after Kawasaki disease: a case-control study［J］. J Pediatr, 2001, 138(3): 400-405.

［12］McCrindle BW, McIntyre S, Kim C, Lin T, Adeli K. Are patients after Kawasaki disease at increased risk for accelerated atherosclerosis?［J］. J Pediatr, 2007, 151(3): 244-248.

［13］Niboshi A, Hamaoka K, Sakata K, Yamaguchi N. Endothelial dysfunction in adult patients with a history of Kawasaki disease［J］. Eur J Pediatr, 2008, 167(2): 189-196.

［14］Dhillon R, Clarkson P, Donald AE, Powe AJ, Nash M, Novelli V, et al. Endothelial dysfunction late after Kawasaki disease［J］. Circulation, 1996, 94(9): 2103-2106.

［15］解玉，王秀英.川崎病冠状动脉病变与内皮功能障碍［J］. 中国当代儿科杂志, 2003, 5(1): 177-179.

［16］Belhassen L, Carville C, Pelle G, Monin JL, Teiger E, Duval-Moulin AM, et al. Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valv suegery［J］. J Am Coll Cardiol, 2002, 39(7): 1139-1144.

［17］Cheung YF, Ho MH, Tam SC, Yung TC. Increased high sensitivity C-reactive protein concentrations and increased arterial stiffness in children with a history of Kawasaki disease［J］. Heart, 2004, 90(11): 1281-1285.