Findings in the pulmonary vascular bed in the remote phase after Kawasaki disease.
Findings in the pulmonary vascular bed in the remote phase after Kawasaki disease.
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DOI：
10.1016/j.amjcard.2011.11.062
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发表时间：
2012-04
期刊：
影响因子：
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通讯作者：
M. Sugimoto;H. Ishido;M. Seki;S. Masutani;Akiko Tamai;H. Senzaki
中科院分区：
文献类型：
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作者：
M. Sugimoto;H. Ishido;M. Seki;S. Masutani;Akiko Tamai;H. Senzaki
川崎（KD）是一种引起动脉壁（包括肺动脉）慢性变化的系统性血管炎。本研究的目的是验证KD消退后肺动脉壁特性和血流动力学异常的假设。对47例急性期川崎病合并冠状动脉病变（CAL）患者（平均年龄7.8 ± 5.7岁）和42例对照患者（平均年龄6.7 ± 4.6岁）进行心导管检查（发病后4.8 ± 4.5年），测量肺动脉输入阻抗。KD患者分为2组：28例持续性CAL，19例CAL消退。KD患者与正常对照组之间的特征阻抗和外周血管阻力无显著差异。与对照组相比，持续性CAL患者的肺动脉顺应性显著降低，表明外周肺血管床的壁硬度增加（p <0.05，方差分析）。与其他组相比，持续性CAL患者也表现出波反射增加（p <0.05，方差分析）。总之，与CAL消退的患者不同，持续性CAL患者在KD后肺动脉的机械性能和血流动力学异常。连同先前关于冠状动脉和全身动脉的异常性质的报告，这些数据表明KD血管炎在不同程度和范围上引起整个动脉系统中动脉壁性质的慢性变化。肺床和其他动脉系统中这些异常的命运及其潜在的不良反应必须在长期随访中进行监测。
Kawasaki disease (KD) is a form of systemic vasculitis that causes chronic changes in arterial walls, including pulmonary arteries. The aim of this study was to test the hypothesis that pulmonary arterial wall properties and hemodynamics are abnormal after the resolution of KD. Pulmonary arterial input impedance was measured during cardiac catheterization (4.8 ± 4.5 years after disease onset) in 47 consecutive patients (mean age 7.8 ± 5.7 years) with KD and coronary artery lesions (CALs) in the acute phase and 42 control patients (mean age 6.7 ± 4.6 years). Patients with KD were subdivided into 2 groups: 28 with persistent CALs and 19 with regressed CALs. There were no significant differences in characteristic impedance and peripheral vascular resistance between patients with KD and controls. Compared with controls, patients with persistent CALs had significantly lower pulmonary arterial compliance, suggesting increased wall stiffness of the peripheral pulmonary vascular bed (p <0.05, analysis of variance). Patients with persistent CALs also exhibited increased wave reflection compared with other groups (p <0.05, analysis of variance). In conclusion, unlike patients with regressed CALs, patients with persistent CALs have abnormal mechanical properties and hemodynamics of the pulmonary artery after KD. Together with previous reports of abnormal properties of coronary and systemic arteries, these data suggest that KD vasculitis causes chronic changes in arterial wall properties in the entire arterial system to varying degrees and extent. The fate of these abnormalities in the pulmonary bed and other arterial systems and their potential adverse effects must be monitored in long-term follow-up.