Coronary artery involvement in children with Kawasaki disease - Risk factors from analysis of serial normalized measurements
Coronary artery involvement in children with Kawasaki disease - Risk factors from analysis of serial normalized measurements
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DOI：
10.1161/circulationaha.107.690875
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发表时间：
2007-07-10
期刊：
影响因子：
37.8
通讯作者：
Newburger, Jane W.
中科院分区：
文献类型：
--
作者：
McCrindle, Brian W.;Li, Jennifer S.;Newburger, Jane W.
背景-大多数关于川崎病冠状动脉受累和相关危险因素的研究都采用日本卫生部的二分标准。串行标准化动脉测量的分析可能会揭示一个更广泛的连续频谱的参与和不同的risk factors.Methods和结果-临床，实验室和超声心动图测量基线和1周和5周后，介绍了190川崎患者作为一个临床试验的一部分，脉冲类固醇治疗的主要治疗，除了标准的静脉注射免疫球蛋白。在所有时间点，标准化为体表面积的最大冠状动脉z评分均显著高于正常值，并随时间推移较基线显著降低。26%的患者在任何时间的最大z评分>= 2.5。23%的患者符合日本卫生部的尺寸标准。与任何时间z评分较高相关的重要独立因素包括患者年龄较轻、从疾病发作到静脉注射免疫球蛋白治疗的间隔较长、基线时血清IgM水平较低和最低血清白蛋白水平较低。z分数的近端右冠状动脉高于那些在左前降支分支。结论-分析系列标准化冠状动脉测量最佳治疗的川崎病患者表明，对于大多数患者，测量是最大的基线，随后减少;基线测量似乎是很好的预测参与在早期随访。当使用更精确的评估时，冠状动脉受累的危险因素与任意二分标准定义的危险因素相似。
Background - Most studies of coronary artery involvement and associated risk factors in Kawasaki disease have used the Japanese Ministry of Health dichotomous criteria. Analysis of serial normalized artery measurements may reveal a broader continuous spectrum of involvement and different risk factors.Methods and Results - Clinical, laboratory, and echocardiographic measurements obtained at baseline and 1 week and 5 weeks after presentation were examined in 190 Kawasaki disease patients as part of a clinical trial of primary therapy with pulse steroids in addition to standard intravenous immunoglobulin. Maximum coronary artery z score normalized to body surface area was significantly greater than normal at all time points, decreasing significantly over time from baseline. A maximal z score >= 2.5 at any time was noted in 26% of patients. Japanese Ministry of Health dimensional criteria were met by 23% of patients. Significant independent factors associated with greater z score at any time included younger patient age, longer interval from disease onset to treatment with intravenous immunoglobulin, lower serum IgM level at baseline, and lower minimum serum albumin level. z Scores of the proximal right coronary artery were higher than those in the left anterior descending branch.Conclusions - Analyses of serial normalized coronary artery measurements in optimally treated Kawasaki disease patients demonstrated that for most patients, measurements are greatest at baseline and subsequently diminish; baseline measurements appear to be good predictors of involvement during early follow-up. When a more precise assessment is used, risk factors for coronary artery involvement are similar to those defined with arbitrary dichotomous criteria.