Persistent high fever for more than 10 days during acute phase is a risk factor for endothelial dysfunction in children with a history of Kawasaki disease.
Persistent high fever for more than 10 days during acute phase is a risk factor for endothelial dysfunction in children with a history of Kawasaki disease.
复制标题
急性期持续高热10天以上是有川崎病病史的儿童发生内皮功能障碍的危险因素。
DOI：
10.1016/j.jjcc.2015.08.008
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Tamai H.
中科院分区：
文献类型：
--
作者：
Mori Y;Katayama H;Kishi K;Ozaki N;Shimizu T;Tamai H.
背景：有川崎病病史的儿童曾报道过内皮功能障碍，但川崎病患者内皮功能的决定因素尚不清楚。在这项研究中，我们调查了川崎病患者的内皮功能，并试图确定持续内皮功能障碍的危险因素。方法使用高分辨率超声，我们测量了67例川崎病病史患者和28例年龄和性别匹配的对照组的动脉对反应性充血的反应——血流介导扩张的百分比，以评估内皮功能。我们将川崎病患者分为内皮功能受损组（血流介导的扩张百分比低于对照组的- 2个标准差）和内皮功能正常组（血流介导的扩张百分比大于对照组的- 2个标准差）。进行Logistic多元回归分析以确定内皮功能受损的独立预测因素。结果川崎病患者血流介导扩张率（9.8±3.6%）明显低于对照组（13.1±3.4%），p< 0.01。在13例川崎病患者中（3例冠状动脉病变和10例无冠状动脉病变），血流介导的扩张百分比低于控制的- 2个标准差。Logistic多元回归分析显示，急性期发热时间大于10 d是内皮功能障碍的显著危险因素（优势比：8.562；95%可信区间：1.366 ~ 53.68）。冠状动脉病变的存在并不是内皮功能障碍的决定因素。结论川崎病患儿存在全身性内皮功能障碍，急性期发热期超过10天是内皮功能障碍的独立预测因子，与冠状动脉受累无关。
BackgroundEndothelial dysfunction has previously been reported in children with a history of Kawasaki disease, but the determinants of endothelial function in Kawasaki disease patients are still unknown. In this study, we investigated endothelial function in Kawasaki disease patients and attempted to identify risk factors for persistent endothelial dysfunction.MethodsUsing high-resolution ultrasound, we measured the percent flow-mediated dilatation, an arterial response to reactive hyperemia, to evaluate endothelial function in 67 patients with a history of Kawasaki disease and 28 age- and sex-matched control subjects. We divided the Kawasaki disease patients into a group with impaired endothelial function (the percent flow-mediated dilatation below −2 standard deviations of the control group) and a group with normal endothelial function (the percent flow-mediated dilatation more than −2 standard deviations of control). Logistic multiple regression analysis was performed to identify independent predictors of impaired endothelial function.ResultsIn Kawasaki disease patients, the percent flow-mediated dilatation was significantly lower than in the control subjects (9.8 ± 3.6%, compared with 13.1 ± 3.4%,p< 0.01). In 13 Kawasaki disease patients (3 patients with coronary artery lesions and 10 patients without coronary artery lesions), the percent flow-mediated dilatation was below −2 standard deviations of control. Logistic multiple regression analysis showed that a febrile period of longer than 10 days during the acute phase was the significant risk factor for endothelial dysfunction (odds ratio: 8.562; 95% confidence interval: 1.366–53.68). Presence of coronary artery lesions was not a determinant of endothelial dysfunction.ConclusionsSystemic endothelial dysfunction exists in children with a history of Kawasaki disease, and a febrile period of longer than 10 days during the acute phase is an independent predictor of endothelial dysfunction irrespective of coronary artery involvement.