Tachycardia as a potential risk indicator for coronary arterial lesions in Kawasaki disease

Tachycardia is frequently observed in the acute phase of Kawasaki Disease (KD) patients. However, little is known about the association between the tachycardia in the acute phase of KD and the development of coronary arterial lesions (CAL). We examined the association between the mean 24 h heart rate in the acute phase of KD observed using 24 h ambulatory ECG monitoring (24 h-ECG) and the occurrence of CAL in patients. In a study conducted between 1994 and 1997, 26 patients with KD underwent 24 h-ECG within the febrile period and before the 9th day of illness. We compared the mean 24 h heart rate based on 24 h-ECG between patients with and those without CAL. Of 26 patients, 7 had CAL. The groups with and without CAL had similar baseline characteristics. The mean 24 h heart rate in the group with CAL was significantly higher than that in the group without CAL (144 ± 14 vs. 124 ± 22, P = 0.033). On multiple regression analysis, the mean 24 h heart rate was significantly correlated with the development of CAL (P = 0.019). Conclusion Marked tachycardia detected by 24 h-ambulatory ECG monitoring in the acute phase of Kawasaki disease might provide important information on the development of coronary arterial lesions. Received: 18 May 1998 / Accepted in revised form: 23 September 1998     

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??Abstract?? Objective To analyze the characteristics and risk factors of coronary artery lesions ??CAL?? in Kawasaki disease ??KD?? based on the clinical grading. Methods The clinical records of 1253 KD patients admitted to Children’s Hospital of Fudan university from January 2000 to June 2011 were analyzed retrospectively. Results ??1??Coronary arterial lesions occurred in 304 cases with the incidence of 24.3% in KD patients. According to the clinical grading of CAL of KD?? among 304 CAL patients?? 32 cases ??10.5%?? were grade II??251 cases ??82.6%?? were grade ?? 13 cases ??4.3%?? were grade ????and 8 cases??2.6%?? were grade V?? with the prevalence in KD patients of 2.6%??20.0%??1.0%??and 0.64% respectively. ??2??In all CAL patients?? single?? double?? three and four coronary branch lesions accounted for 42.4%?? 29.3%??16.1% and 12.2% respectively. The lesions of left main trunk??left anterior descending branch??left circumflex branch and right coronary artery accounted for 43.5 %??18.6%??6.8 % and 31.1% of all the branches involved respectively. ??3??The results of single factor analysis and multivariate logistic regression analysis showed that incomplete KD and elevated C reactive protein ????100 mg/L?? were the risk factors of grade ?? CAL?? while male sex?? age younger than 1 year?? duration of fever over 10 days?? incomplete KD and low serum albumin ????30 g/L?? were the risk factors of Grade ????CAL. Conclusions ??1??Grade III CAL is the most common type in KD patients, accounting for 82.6% of CAL. ??2??About 57.6% CAL occurs in two and abovetwo branches of coronary arteries. ??3??The most frequently involved branch is left main trunk, followed by right coronary artery??left anterior descending branch and circumflex branch. ??4??Being male?? age??1 year old?? incomplete KD?? long-lasting fever ????10 d?? and low serum albumin ????30 g/L?? are the independent risk factors of grade ????CAL.     

川崎病患儿并发冠状动脉损害的高危因素分析

目的 探讨川崎病(KD)并发冠状动脉损害(CALs)的高危因素.方法 回顾性分析321例川崎病患儿的临床资料,对与冠状动脉损害发生有关的性别、年龄、发热持续时间、丙种球蛋白使用时间及剂量、WBC、PLT、Hct、CRP、ESR、血浆白蛋白(ALB)等各项因素进行计数资料的X2检验,将单因素分析筛选出的变量进行多因素Logistic回归分析.结果 单因素X2检验显示,性别、发病时年龄、发热持续时间、丙种球蛋白使用时间、WBC、CRP及Hot水平与KD合并CALs有关(P＜0.05);进一步多因素Logistic回归分析显示,丙种球蛋白使用时间、发热持续时间、CRP与CALs的发生有关(P＜0.05).结论 丙种球蛋白使用时间晚、发热持续时间＞10 d、高CRP水平是KD合并CALs的高危因素.     

Harada评分预测川崎病冠状动脉病变的临床意义

目的 探讨Harada评分对中国人群样本中川崎病（KD）合并冠状动脉病变高危因素判断的临床价值。方法 参照KD诊断标准及Harada评分标准,回顾性分析187例KD息儿发病10d内白细胞（WBC）计数、红细胞压积（HCT）、C反应蛋白（CRP）、发热天数、心电图及超声心动图等各项指标;采用χ^2检验和多元回归分析,分别检验上述因素与KD合并冠脉损害的相关性;比较冠脉损害组与非冠脉损害组Harada评分的差异。结果发病10d内单因素分析发病年龄、WBC计数、HCT、CRP、心电图改变及发热天数与KD合并冠脉损害有密切相关性。多因素分析结果显示,发病10d内CRP、发热天数与KD合并冠脉损害的发生独立相关。发生冠脉损害患儿Harada评分的平均分高于无冠脉损害者。结论 Harada评分可作为川崎病冠状动脉病变的一项预见性指标,也可作为中国人群川崎病患者早期是否应用静脉丙球的筛选指标。     

川崎病冠状动脉病变介入疗法的研究现状

川崎病 (Ｋａｗａｓａｋｉｄｉｓｅａｓｅ,ＫＤ)是一种病因不明 ,以全身中、小动脉炎性病变为主要病理改变的急性发热性疾病 ,常见于 5岁以下的小儿 ,以冠状动脉 (简称冠脉 )病变为其最严重的并发症。ＫＤ急性期冠脉瘤 (ｃｏｒｏｎａｒｙａｒｔｅｒｙａｎｅｕｒｙｓｍ ,ＣＡＡ)的发生率约为 10 %～ 2 0 %。随访研究表明 ,约 5 0 %的ＣＡＡ于病后 1～ 2年内自行消退 ,80 %的轻、中度ＣＡＡ于病后5年内消退。ＣＡＡ直径 >5ｍｍ者可能进展为狭窄 ,且瘤体越长可能性越大。巨大ＣＡＡ(直径≥ 8ｍｍ)常不能消退 ,内膜增生伴血栓形成 ,瘤出入口产生…     

川崎病并发冠状动脉病变研究进展

川崎病是一种原因未明的急性全身血管炎性疾病,其主要并发症为冠状动脉病变,包括冠状动脉扩张、冠状动脉瘤形成等,且急性期过后冠状动脉损害持续存在.近年来研究表明,基因多态性、中性粒细胞、单核细胞、细胞因子等多种因素共同参与了冠状动脉病变的形成,长期抗凝药物的使用可降低冠状动脉损害.     

血清25-羟维生素D在佝偻病诊断中的应用价值

目的：探讨血清25 羟维生素D［25（OH）D］在维生素D缺乏性佝偻病早期诊断中的意义。方法：检测对照组（73例）、可疑组（45例）和佝偻病组（65例）的血清25（OH）D、钙、磷、碱性磷酸酶浓度,并通过ROC曲线对血清25（OH）D的诊断价值进行评价。结果：对照组、可疑组和佝偻病组的血清25（OH）D水平分别为112±37、83±30和72±31 nmol/L,后两者均显著低于对照组（F=26.174,P0.05）。可疑组和佝偻病组的维生素D缺乏率均显著高于对照组（χ2=33.346, P0.05）。结论：血清25(OH)D水平在可疑及确诊佝偻病的患儿中显著降低,可以反映维生素D的营养状况,适用于佝偻病的早期筛查。     

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??Abstracts?? Objective To study serum 25-hydroxyvitamin D ??25-hydroxyvitamin D??25??OH??D?? distribution in May in preschool children in Suzhou area?? giving scientific basis for the intake and supplementation of vitamin D for children. Methods Totally 852 cases of preschool children??454 cases of male??398 cases of female?? aged from 3 to 7 years were selected in May of 2012??and all cases were divided into four groups named as 3??4 year group????4??5 year group????5??6 year group and ??6??7 year group.The height and weight of every case were measured and were used to calculate the Body Mass Index??BMI??for evaluating the body shape?? according the normal reference values of P85 and P95 of BMI for children below 7 years old provided by WHO??all cases were classified into overweight or no-overweight??obesity or no obesity groups. Serum 25??OH??D levels were measured by ELISA. Results There were 42.37%??361/852??of cases for preschool children in Suzhou area who showed deficiency of serum 25??OH??D??and insufficiency was presented in 40.38%??344/852?? of cases.For the distribution of 25??OH??D among age groups?? they were 61.20??53.30??75.20??nmol/L??55.50??45.5??65.10??nmol/L??48.30??40.40??57.50??nmol/L and 48.90??40.40??60.20??nmol/L from 3??4 year group to ??6??7 year group in turn. Comparing every two groups?? the serum 25??OH??D declined with the increasing age except between ??5??6 year and??6??7 year group??χ2 =18.10??P=0.47????and it was higher in 3??4 year group than that in ??4??5 year group??χ2 =110.43??P??0.05????higher in ??4??5 year group than that in ??5??6 or ??6??7 year group??χ2 was 106.11 and 87.75??P??0.05 for all??.The distribution of serum 25??OH??D in overweight and no-overweight group was 53.97??45.27??66.45??nmol/L and 52.64??42.85??63.80??nmol/L?? and they were 55.24??47.29??66.56??nmol/L and 52.71??43.11??63.92??nmol/L for obesity and no-obesity group??there existing significant difference for the distribution of 25??OH??D between every two groups??χ2 was 7.10 and 6.73??P??0.05??. Serum 25??OH??D and BMI showed positive correlation??r = 0.11??P??0.05??. Conclusion The overall insufficiency of serum 25??OH??D exists in preschool children in Suzhou area??and positive correlation exists between BMI and serum 25??OH??D in children. It suggests that we should reinforce the monitoring of serum 25??OH??D in preschool children??taking scientific measures to strengthen the intake and supplementation of vitamin D.     

川崎病患儿25-羟基维生素D_3水平变化及意义

目的研究川崎病(KD)患儿血清25-羟基维生素D3[25-(OH)D3]水平的变化及意义。方法收集2012年1月至2015年8月242例KD患儿的临床资料,根据有无冠状动脉损伤(CAL)分为CAL组(63例)和非CAL组(NCAL,179例),并且按照IVIG治疗效果分为IVIG敏感组(219例)和IVIG无反应组(23例)。选择同期40例健康儿童(对照组)和急性上呼吸道感染患儿40例(上感组)为对照,通过酶联免疫法检测各组血清25-(OH)D3水平。结果 IVIG治疗前:上感组、NCAL组和CAL组25-(OH)D3水平低于对照组(P0.05),以CAL组最低(P0.05);上感组、IVIG敏感组和IVIG无反应组25-(OH)D3水平均低于对照组(P0.05),以IVIG无反应组最低(P0.05)。IVIG治疗后:CAL组的25-(OH)D3水平低于NCAL组及对照组(P0.05);IVIG无反应组的25-(OH)D3水平低于IVIG敏感组及对照组(P0.05),以IVIG无反应组最低(P0.05)。结论 KD患儿25-(OH)D3水平下降,而且降低越明显,出现CAL以及无反应型KD的可能性越大。     

超声心动图探查川崎病冠状动脉病变259例

目的 探讨超声心动图在诊断及随访川崎病冠状动脉病变中作用。方法 超声心动图探查小儿川崎病259例,对其中97例进行了随访。结果 发现冠状动脉病变48例(18.5％),90％是在病程3周内出现,左冠状动脉比右冠状动脉更易发生扩张性病变。随访表明轻度扩张性病变较易恢复正常,2例冠状动脉瘤持续存在,动脉瘤内径大小是影响预后的主要因素。结论 超声心动图是诊断川崎病并发冠状动脉病变安全和准确的方法。     

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目的探讨川崎病(KD)患儿合并冠状动脉损伤的危险因素。方法按照KD诊断标准,对北京儿童医院2000-01-01—2004-12-31收治的644例KD患儿临床资料、治疗方法以及实验室资料进行分析。结果Pear-son卡方检验显示,患儿性别、发热持续时间、丙种球蛋白使用时间、丙种球蛋白使用剂量、血沉及C反应蛋白与KD合并冠状动脉损伤有关(P<0·05);进一步多因素Logistic回归分析显示,性别、发热持续时间、丙种球蛋白使用剂量与冠状动脉扩张显著独立相关(P<0·05)。结论对男性、发热持续时间长的KD患儿应予足够重视,早期足量使用丙种球蛋白以减少或减轻冠状动脉并发症。     

儿童川崎病并冠状动脉瘤冠状动脉造影及心脏超声长期随访

川崎病(Kawasaki disease,KD)基本病理改变为全身性血管炎,主要侵犯大、中血管,其中冠状动脉(简称冠脉)是最常受损的血管,冠状动脉瘤(coro-     

川崎病并发冠状动脉病变的病因及其发病机制

川崎病是一种以全身中小血管炎为主要病理改变的急性发热性出疹性小儿疾病.该病的长期预后决定于其心血管并发症,尤其是冠状动脉病变(coronary artery lesion,CAL)程度.川崎病并发的CAL临床治疗非常棘手.目前研究显示CAL的发生与超抗原、巨细胞病毒、RNA病毒等特殊病原体感染相关,一些共刺激分子、细胞因子、趋化因子、金属基质蛋白酶、三磷酸肌醇激酶等基因多态性也参与CAL发生;对川崎病动物模型及川崎病死亡患儿的冠状动脉研究发现,免疫系统异常活化、免疫细胞浸润冠状动脉致冠状动脉内皮细胞功能紊乱、细胞基质降解是CAL发病的关键步骤.该文就川崎病并发CAL的病因及其发病机制研究进展进行综述.     

川崎病冠状动脉损害易患基因研究进展

川崎病是一种好发于5岁以下儿童的急性全身性中、小血管炎性综合征,该病的病因和发病机制至今尚未明确.流行病学资料显示川崎病的发病存在明显的种族差异,在亚裔人群中的发病率明显高于非亚裔人群.冠状动脉损害是川崎病最为严重的并发症,可导致缺血性心肌病、心肌梗死甚至猝死,未经治疗的患儿约25％会发生冠状动脉损害,而经过治疗的患儿冠状动脉损害发生率仍为5％.近年来该病已取代风湿热成为发达国家儿童获得性心脏病最常见的病因.目前关于冠状动脉损害的研究是川崎病的研究热点,而遗传因素在川崎病及冠状动脉损害的发生过程中起重要作用.研究显示ITPCK、CASP3、TNF-α、CD40、IL-10、PELI1、GRIN3A、CTLA-4、SNX24、LRP1B等多种基因易患性与川崎病冠状动脉损害密切相关,该文就川崎病患儿冠状动脉损害易患基因研究进展作一综述.     

川崎病合并冠状动脉损害的遗传学基础

川崎病（KD）主要危及生命的并发症是冠状动脉损害（CAL）,引起冠状动脉狭窄、血栓形成、动脉瘤破裂等,甚至猝死。KD现已成为儿童后天性心脏病的主要病因。因此,早期发现哪些KD患儿是发生CAL的易患人群,并予及时干预十分重要。遗传因素在KD及其CAL的发生发展中起重要作用,目前已发现多个基因的多态性与CAL相关。该文主要就近年来国内外关于KD合并CAL基因多态性的研究作一综述。     

川崎病并发冠状动脉病变的临床特点

川崎病(Kawasaki disease,KD)又称皮肤黏膜淋巴结综合征(mucocutaneous lymph node syndrome,MCLS),是一种以全身血管炎为主要病变的疾病,可以导致多系统受累,冠状动脉病变(coronary artery lesion,CAL)是急性期最严重的表现,并且与成年后冠脉阻塞和动脉硬化有关~([1.2]).研究发现,性别、发热时间、血白细胞数、血小板、C反应蛋白、血沉和静脉丙种球蛋白(IVIG)初治效果等因素与CAt.的发生有关~([3.4]).但临床上可以经常见到KD患者出现丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)和乳酸脱氢酶(LDH)升高,这些酶的异常升高与CAI的关系的研究尚不多见.本研究对我科近5年来收治的KD临床特点进行回顾性分析,初步探讨上述指标与CAI的关系,为早期发现CAL和判断KD预后提供依据.     

Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants

The relationship between serum 25-hydroxyvitamin D (25-OHD) concentrations and sunshine exposure in 61 term, exclusively breast-fed infants younger than 6 months of age was investigated. Sunshine exposure was quantitated using a sunshine and clothing diary, which was verified by infant-adapted ultraviolet dosimetry. By multiple regression techniques, infant serum 25-OHD concentrations were significantly related to UV exposure and maternal serum 25-OHD concentrations. Infant 25-OHD concentrations correlated with sunshine exposure in infants whose mothers had low (less than 35 ng/ml) or high (greater than 35 ng/ml) serum concentrations of 25-OHD (r = 0.70, P less than 0.001 and r = 0.53, P = 0.004, respectively). Estimates were made to determine sunshine exposure conditions necessary to maintain serum 25-OHD concentrations above the lower limit of the normal range (11 ng/ml). A conservative estimate would be 30 minutes per week wearing only a diaper or 2 hours a week fully clothed without a hat.     

Low serum 25-hydroxyvitamin D levels and bronchiolitis severity in Spanish infants

This cross-sectional study was performed to examine the prevalence of hypovitaminosis D in infants with acute bronchiolitis compared with control subjects and to evaluate the relationship between serum 25-hydroxyvitamin D (25(OH) D) and the severity of bronchiolitis. Serum 25(OH) D levels were measured by radioimmunoassay in 48 infants with acute bronchiolitis (2.5?±?2.0 months) and in 30 healthy infants (3.2?±?2.3 months). 25(OH) D levels (ng/ml) in children with acute bronchiolitis were significantly lower than in the control group (median 29.9 ng/ml (interquartile range (IQR) 21.4–37.5) versus median 38.2 ng/ml ((IQR 26.1–48.1), p?=?0.022), mainly in infants with moderate–severe bronchiolitis (median 29.8 ng/ml, IQR 19.2–35.9). The prevalence of hypovitaminosis D was remarkably greater among infants with bronchiolitis than in control subjects (52.1 versus 26.6 %). A significant inverse correlation was found between serum 25-hydroxyvitamin D levels and disease severity (rho?=??0.457, p?<?0.001). Conclusion: The prevalence of hypovitaminosis D is high in Spanish infants with bronchiolitis. The severity of acute bronchiolitis increases with a decline in serum 25 (OH) D level.     

The association of serum 25-hydroxyvitamin D3 and D2 with depressive symptoms in childhood--a prospective cohort study

Background: Depression in adolescence is common and early onset predicts worse outcome in adulthood. Studies in adults have suggested a link between higher total 25‐hydroxyvitamin D [25(OH)D] concentrations and lower risk of depression. Objectives: To investigate (a) the association between serum 25(OH)D₂ and 25(OH)D₃ concentrations and depressive symptoms in children, and (b) whether the associations of 25(OH)D₂ and 25(OH)D₃ are different from, and independent of, each other. Methods: Prospective cohort study with serum 25(OH)D₂ and 25(OH)D₃ concentrations measured at mean age of 9.8 years and depressive symptoms assessed with the Mood and Feelings Questionnaire by a trained interviewer at the mean ages of 10.6 years (n = 2,759) and 13.8 years (n = 2,752). Results: Higher concentrations of 25(OH)D₃ assessed at mean age 9.8 years were associated with lower levels of depressive symptoms at age 13.8 years [adjusted risk ratio (RR; 95% confidence interval (CI)): 0.90 (0.86–0.95)], but not at age 10.6 years [adjusted RR (95% CI): 0.98 (0.93–1.03)] and with increased odds of decreasing symptoms between age 10.6 and 13.8 years [adjusted RR (95% CI): 1.08 (1.01–1.16)]. Serum 25(OH)D₂ concentrations were not associated with depressive symptoms. Conclusions: This is the first study in children to suggest that the association between 25(OH)D₃ concentrations and depression emerges in childhood. The association is independent of a wide range of potential confounding factors, and appears to be stronger with greater time separation between assessment of 25(OH)D₃ and assessment of depressive symptoms. Confirmation of our findings in large prospective studies and trials would be valuable.