川崎病冠脉瘤患儿远期血管内皮功能的研究

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

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.