川崎病患儿恢复期血管内皮功能与急性期C-反应蛋白关系

目的 探索性研究川崎病（KD）患儿恢复期外周血管内皮功能与急性期血清C-反应蛋白(CRP)水平及冠状动脉损害（CAL）的关系，探讨外周血管内皮功能测定作为KD患儿血管内膜功能康复指标的可能性。方法 纳入复旦大学附属儿科医院（我院）心内科住院、具备完整的急性期临床资料、病程>2个月，并于我院心内科随访的KD患儿。采用EndoPat2000仪器测定外周血管内皮功能，记录反应性充血-外周动脉张力指数（RHI）。将血清CRP值转化为有序多分类资料进行分析,划分切点为第20、40、60、80和100百分位，分为5组。观察KD患儿RHI分布的特征。调整患儿年龄和性别后，分析RHI与急性期血清CRP的关系；比较发生和未发生CAL的KD患儿血清CRP和RHI水平的差异。结果 26例KD患儿进入本研究，男21例。平均年龄（83±24）个月，平均病程（27±17）个月。急性期CRP平均水平为91.9 mg·L-1。平均RHI为1.3 mL·mm-1 Hg×100。调整了年龄和BMI Z评分后，RHI与CRP呈负相关（R2= 0.411 9，Pmodel=0.025 3，b=-0.483,PCRP＝0.019）。发生CAL的KD患儿的RHI水平低于未发生CAL患儿，（1.04 ±1.10） vs （1.34 ±0.08） mL·mm-1 Hg×100，P=0.054，急性期的CRP水平在发生和未发生CAL的KD患儿间差异无统计学意义。结论 急性期CRP水平与KD恢复期外周血管内皮功能存在负相关，即CRP水平越高，内皮功能受损越严重；发生CAL患儿内皮功能损伤更严重。

Study on association between peripheral endothelial function of patients with Kawasaki disease and circulating C-reaction protein levels at onset

Objective To explore if the peripheral endothelial function of patients with Kawasaki disease(KD) is associated with circulating CRP levels during acute phase before treatment, or coronary artery lesion (CAL), providing evidence to support the possibility to use endothelial function as a measure of recovery of vascular endometrium from inflammation. Methods Patients diagnosed as KD and treated in Children′s Hospital of Fudan University with complete clinical personal and clinical data were recruited at their follow up hospital visit. Peripheral endothelial function was examined by using EndoPat2000 with standard protocol by the same trained nurse, RHI was reported and analyzed including the distribution of RHI measurement. The correlation between RHI and CRP levels during acute phase of disease, and with CAL was analyzed by generalized linear model. Results In total 26 eligible patients were recruited, including 21 males, aged 5 to 13 years, and the duration after treatment ranged from 2 months to 5 years. The patients had average BMI of 0.93 s compared with the national level for the given age at recruitment. The mean level of CRP before treatment was 91.9 mg·L-1, the mean RHI at follow-up visit was 1.3 mL·mm-1 Hg×100. The original RHI measurement met normal distribution. After adjustment of age and Z score of body mass index (Z-BMI), RHI was negatively correlated with CRP percentiles （R2= 0.411 9，Pmodel=0.025 3，b= -0.483,PCRP＝0.019）. Patients with CAL had significantly lower RHI levels compared with patients who had no CAL, (1.04 ±1.10) vs (1.34 ±0.08) mL·mm-1 Hg×100, P=0.054. CRP levels at acute phase were not significantly different between the two groups of patients. Conclusion Patients with Kawasaki disease had impaired endothelial function during the recovery phase, and was significantly correlated with their inflammation severity before IVIG treatment. Patients with CAL had worse endothelial function than those without CAL. Non-invasive peripheral endothelial function can be considered as a biomarker to indicate recovery of vascular endometrium function for KD patients.