Vasculitis after Kawasaki disease is a possibility of risk factors for cerebrovascular disease?

目的：明确川崎病（KD）后血管炎是脑血管病的可能危险因素。【患者和方法】我们选择27例伴有冠状动脉病变的KD患者（A组），12例冠状动脉病变完全消退的KD患者（B组），10例急性期冠状动脉正常的KD患者（C组）和17例健康对照（CONT）。采用高分辨率超声系统测量右颈动脉远端内膜-中膜厚度（IMT）、收缩期内径、舒张期内径、血压。用已知公式计算颈动脉僵硬度和膨胀性。采用激光多普勒监测系统（PeriFlux system 5000）监测外周血管功能（监测静息激光多普勒灌注单位（rest PU），然后将前臂袖带充气至200 mm Hg， 3分钟后突然解除闭塞，记录最大激光多普勒灌注单位（max PU）和到达最大灌注时间（time to max PU），直至充血消退）。<结果> A的刚度显著高于其他三组，A的膨胀性显著低于其他三组。IMT、rest PU、max PU差异无统计学意义。然而，A组达到PU最大值的时间明显长于其他3组。<结论>这些数据表明，冠状动脉退行性和正常冠状动脉患者的颈动脉壁厚度与正常冠状动脉相同，但更硬、可扩张，外周微血管功能，包括内皮，均正常。这些可能提示KD合并CAL患者存在临床前动脉粥样硬化和脑血管疾病的可能性，需要进一步研究来解决KD后的临床和病理预后问题。

<Purpose> To clarify the Vasculitis after Kawasaki disease(KD) is a possibility of risk factors for cerebrovascular disease。<patients and methods> we selected 27 KD patients with coronary artery lesion(CAL)(Group A), 12 KD patients with completely regressed Coronary lesions(Group B), 10 KD patients who had normal coronary arteries during the acute phase(Group C), and 17 healthy controls(CONT). Using high-resolution ultrasound system, distal intima-media thickness(IMT), systolic and diastolic internal diameter of right carotid artery, blood pressure were measured. Carotid arterial stiffness and distensibility were calculated using known formula. Using laser-Doppler monitoring system(PeriFlux system 5000), peripheral vascular function(The resting laser Doppler perfusion unit(rest PU) was monitored and then the forearm cuff was inflated to 200 mm Hg. After 3 minutes occlusion was suddenly released and maximum laser Doppler perfusion unit(max PU) and time to maximum perfusion(Time to max PU) were recorded till hyperemia subsided.) were measured.<results> Stiffness of A was significantly higher than the other three groups and distensibility of A was significant lower than the other three groups. There were no significant differences in IMT, rest PU and max PU. However, Time to max PU in group A was significantly longer than in the other 3 groups.<Conclusion> These data indicates that carotid arterial wall in patients with CAL is as thick as normal but stiffer and distensible, and peripheral micro-vascular function, including endothelium, was normal in patients with regressed coronary arteries and normal coronary arteries, and impaired in patients with CAL. These may point towards possibility of preclinical atherosclerosis and cerebrovascular disease in patients with KD wit CAL. Furtherinvestigation must be need to resolve clinical and pathological prognosis after KD.