CORONARY ARTERY ABNORMALITIES

冠状动脉异常

• 批准号: 7960437
• 负责人: ANDRAS BRATINCSAK
• 金额: $ 1.42万
• 依托单位: UNIVERSITY OF HAWAII AT MANOA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7960437
• 关键词: 6 year old; Academy; American; American Heart Association; Anterior; Arteries; Blood Circulation; Body Surface Area; Caliber; Child; Clinical; Clinical Research; Computer Retrieval of Information on Scientific Projects Database; Coronary Circulation; Coronary artery; Detection; Diagnosis; Diagnostic; Dilatation - action; Echocardiography; Etiology; Fever; Funding; Gold; Grant; Guidelines; Hawaii; Health; High Cardiac Output; Incidence; Inflammatory; Institution; Intravenous Immunoglobulins; Japanese Population; Lead; Lesion; Life; Lymphatic Diseases; Measurement; Measures; Metabolic; Methods; Morbidity - disease rate; Mucocutaneous Lymph Node Syndrome; Myocardial Ischemia; Normal Range; Patients; Pediatrics; Process; Reporting; Research; Research Infrastructure; Research Personnel; Resources; Right coronary artery structure; Source; Time; United States; United States National Institutes of Health; Vasculitis; Vasodilation; age related; base; left coronary artery; mortality; prevent; response; two-dimensional

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Kawasaki disease (KD), a general vasculitis illness characterized by fever, mucocutaneous lesions and lymphadenopathy, is three times more prevalent in Hawaii than in the continental United States: 45 cases/100,000 children/year in Hawaii. Despite its high incidence, the etiology of KD is still unknown. Two weeks after diagnosis of KD, coronary artery abnormalities (CAA) can be demonstrated in up to 25% of the cases. The introduction of IVIG therapy had reduced the incidence of CAA to 8%. CAA may lead to myocardial ischemia later in life increasing the morbidity and mortality of KD. Therefore, diagnosing and adequately treating KD is crucial to preventing CAA and its long-term complications. The diagnosis of KD is based on clinical features, but in clinically incomplete presentations, CAA itself may be part of the diagnostic criteria according to the guidelines of the American Heart Association and the American Academy of Pediatrics. The gold standard method of detecting CAA is 2-dimensional echocardiography measuring the diameter of three coronary arteries: left main coronary artery (LMCA), left anterior descending artery (LAD) and right coronary artery (RCA). Normal values of coronary arteries in children and the detection of abnormalities were previously based on criteria constituted by the Japanese Ministry of Health. Instead of these age dependent values, de Zorzi et al introduced normal values and Z-scores (standard deviation from normal) based on the body surface area of children. Their study reported a much higher incidence of CAA associated with KD, especially in the early, febrile period of the illness. Fever, a general response to infectious and inflammatory processes, results in redistribution of blood circulation and vasodilation of specific vessels. Increased metabolic rate in fever demands higher cardiac output that requires increased coronary circulation. Thus, it can be hypothesized that fever itself may result in dilatation of the coronary arteries. What causes the specific vasculitis of the coronary arteries in a febrile illness like KD is yet to be determined. In this study we aim to compare the diameter of three coronary arteries in febrile and non-febrile children. The coronary artery measurements of hospitalized patients (6 months to 6 years old children) in a febrile period of their illness will be compared to coronary artery measurements of healthy non-febrile children, who previously underwent echocardiography. CAA will be determined according to de Zorzi's criteria. We will also determine the diameter of the coronary arteries of patients with Kawasaki disease in Hawaii and compare it to de Zorzi's standardized Z-score measurements. If the hypothesis, that fever itself may result in transient coronary artery dilatation, proves to be valid, the diagnostic criteria of incomplete KD may need to be revised.

该副本是利用众多研究子项目之一 由NIH/NCRR资助的中心赠款提供的资源。子弹和 调查员（PI）可能已经从其他NIH来源获得了主要资金， 因此可以在其他清晰的条目中代表。列出的机构是 对于中心，这不一定是调查员的机构。 川崎病（KD）是一种以发烧，粘膜性病变和淋巴结肿大为特征的普通血管炎，在夏威夷疾病是夏威夷大陆的三倍：夏威夷的45例/100,000例儿童/年。 尽管发病率很高，但KD的病因仍然未知。 诊断为KD两周后，可以在多达25％的病例中证明冠状动脉异常（CAA）。 IVIG疗法的引入将CAA的发病率降低到8％。 CAA可能导致生命后期的心肌缺血，从而增加KD的发病率和死亡率。 因此，诊断和充分治疗KD对于防止CAA及其长期并发症至关重要。 KD的诊断是基于临床特征，但是在临床上不完整的演示中，CAA本身可能是根据美国心脏协会和美国儿科学会的指南成为诊断标准的一部分。 检测CAA的黄金标准方法是二维超声心动图测量了三个冠状动脉的直径：左主冠状动脉（LMCA），左前降动脉（LAD）和右冠状动脉（RCA）。 冠状动脉动脉在儿童中的正常值和异常检测以前是基于日本卫生部构成的标准。 De Zorzi等人不是这些年龄依赖性值，而是根据儿童的身体表面积引入了正常值和z得分（与正常偏差）。 他们的研究报告说，与KD相关的CAA发病率要高得多，尤其是在疾病的早期发热时期。 发烧，对传染和炎症过程的一般反应，导致血液循环的重新分布和特定血管的血管舒张。 发烧的代谢率提高需要更高的心输出量，这需要增加冠状动脉循环。 因此，可以假设发烧本身可能导致冠状动脉扩张。 在像KD这样的高热疾病中导致冠状动脉的特异性血管炎的原因尚未确定。 在这项研究中，我们旨在比较发热和非狂热儿童中三个冠状动脉的直径。在生病的高温期内，住院患者（6个月至6岁儿童）的冠状动脉测量将与以前接受超声心动图的健康非毛细血管儿童的冠状动脉测量进行比较。 CAA将根据De Zorzi的标准确定。我们还将确定夏威夷川崎疾病患者冠状动脉动脉的直径，并将其与De Zorzi的标准化Z分数测量值进行比较。 如果该假设本身可能导致短暂的冠状动脉扩张，这是有效的，则可能需要修改不完全KD的诊断标准。