Impaired endothelial function in the brachial artery after Kawasaki disease and the effects of intravenous administration of vitamin C
Impaired endothelial function in the brachial artery after Kawasaki disease and the effects of intravenous administration of vitamin C
复制标题
DOI：
10.1097/00006454-200301000-00011
复制
发表时间：
2003-01-01
影响因子：
3.6
通讯作者：
Li, CL
中科院分区：
文献类型：
--
作者：
Deng, YB;Li, TL;Li, CL
背景既往对有川崎病病史患者的研究主要集中在冠状动脉的血管内皮功能，而对全身动脉的内皮功能尚未完全了解。此外，维生素C对川崎后全身内皮功能的影响尚未阐明。我们试图通过高分辨率超声检查分析川崎后肱动脉的内皮依赖性血管舒张，并研究急性给予维生素C是否可以恢复这种全身性内皮功能障碍。我们比较了39例急性川崎后1.0至9.6年的患者（7.1 ± 2.7年）和17例匹配的健康受试者（7.0 ± 3.1年）作为对照。使用高分辨率血管超声，我们测量了肱动脉对反应性充血（流量增加导致内皮依赖性扩张）和舌下含服硝酸甘油（导致内皮非依赖性扩张）的反应。在有川崎病史的患者中，反应性充血引起的肱动脉直径变化百分比（6.2 ± 3.9%）显著低于对照组（14.1 ± 6.8%; P < 0.0001）。对照组（33.2 +/- 13.7%）和有川崎病史的患者（30.6 +/- 9.2%; P = 0.49）舌下含服硝酸甘油引起的直径变化百分比无显著差异。在接受丙种球蛋白治疗的患者（6.0 ± 4.0%）和未接受丙种球蛋白治疗的患者（7.9 ± 3.3%; P = 0.33）之间，反应性充血引起的肱动脉直径变化百分比无显著差异。对19例有川崎病史的患者，静脉滴注维生素C可显著增加反应性充血引起的肱动脉内径变化百分比（6.6 +/- 3.5至13.0 +/- 5.5%; P < 0.0001），而20例有肱动脉反应性充血病史的患者，反应性充血引起的肱动脉直径变化百分比无显著增加。安慰剂给药后的川崎发生率（6.5 +/- 4.5至7.3 +/- 4.9%; P = 0.20）。我们的研究显示，与健康儿童相比，有川崎病病史的患者反应性充血引起的肱动脉直径变化百分比降低，表明川崎病后存在全身性内皮功能障碍。虽然川崎病后的这种全身性内皮功能障碍不受川崎病急性期早期大剂量丙种球蛋白治疗的影响，但可以通过急性静脉注射维生素C来恢复。
Background. Previous studies in patients with a history of Kawasaki disease have focused on vascular endothelial function in coronary arteries, and the endothelial function of systemic arteries is not fully understood. Furthermore the effect of vitamin C on systemic endothelial function after Kawasaki disease has not been elucidated.Objectives. We attempted to analyze endothelium-dependent vasodilatation in the brachial artery after Kawasaki disease by using high resolution ultrasonography and to investigate whether the acute administration of vitamin C could restore such systemic endothelial dysfunction.Methods. We compared 39 patients (7.1 +/- 2.7 years) 1.0 to 9.6 years after acute Kawasaki disease with 17 matched healthy subjects (7.0 +/- 3.1 years) as controls. Using high resolution vascular ultrasound, we measured brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilatation) and sublingual nitroglycerin (causing endothelium-independent dilatation).Results. The percent change in diameter of the brachial artery induced by reactive hyperemia in the patients with a history of Kawasaki disease (6.2 +/- 3.9%) was significantly lower than that in the control group (14.1 +/- 6.8%; P < 0.0001). No significant difference could be found in percent change in diameter induced by sublingual administration of nitroglycerin between the control (33.2 +/- 13.7%) and the patients with a history of Kawasaki disease (30.6 +/- 9.2%; P = 0.49). There was no significant difference in percent change in diameter of the brachial artery induced by reactive hyperemia between the patients who received gamma-globulin (6.0 +/- 4.0%) and those who did not receive gamma-globulin (7.9 +/- 3.3%; P = 0.33). Intravenous infusion of vitamin C significantly increased the percent change in diameter of brachial artery induced by reactive hyperemia in 19 patients with history of Kawasaki disease (6.6 +/- 3.5 to 13.0 +/- 5.5%; P < 0.0001), whereas no significant increase was seen in the percent change in diameter of brachial artery induced by reactive hyperemia in 20 patients with history of Kawasaki disease after placebo administration (6.5 +/- 4.5 to 7.3 +/- 4.9%; P = 0.20).Conclusions. Our study showed decreased percent change in diameter of the brachial artery induced by reactive hyperemia in patients with history of Kawasaki disease compared with the healthy children, indicating that systemic endothelial dysfunction exits after Kawasaki disease. Although such systemic endothelial dysfunction after Kawasaki disease is not influenced by early treatment with high dose gamma-globulin in the acute stage of Kawasaki disease, it can be restored by the acute intravenous administration of vitamin C.