ABSTRACT
<p><b>OBJECTIVE</b>Kawasaki disease is an acute systemic vasculitis syndrome primarily affecting small and medium-sized arteries, with development of severe coronary artery lesion (CAL). CAL may induce myocardial infarction and sudden death. So it is very important to find CAL early. In this study the value of multislice spirral computed tomography (MSCT) was investigated to find CAL in patients with Kawasaki disease.</p><p><b>METHODS</b>Thirty-four patients with Kawasaki disease were examined respectively by using MSCT and two dimensional echocardiography (TDE), then the findings were analyzed.</p><p><b>RESULTS</b>MSCT showed CAL in 12 of 34 patients involving 16 coronary arteries, including 9 (26%) dilated left coronary arteries (LCA), 1 constricted, 1 calcified and 1 LCA which had both stenosis and 4 (12%) dilated right coronary artery. TDE showed that 10 patients had 13 dilated coronary arteries, including 7 (21%) left coronary arteries and 6 (18%) right coronary arteries. TDE failed to show the abnormalities in 3 patients with coronary artery stenosis or calcification and in 2 patients with left descending artery dilation demonstrated by MSCT. However, no significant difference was found between the two methods (P > 0.05) in the rates of positive findings. The correlation between TDE and MSCT, in left as well as right coronary artery, was significantly positive (r = 0.90, r = 0.82, respectively, P < 0.01). However, compared with TDE, MSCT was significantly better in finding coronary artery stenosis and calcification (chi(2) = 24.3, P < 0.01).</p><p><b>CONCLUSIONS</b>Use of MSCT may help better find the lesions of coronary artery, especially those in middle and distant sections as compared to TDE. MSCT is better than TDE in exploring coronary wall calcification and coronary artery stenosis. MSCT could be a helpful new addition to the current CAL monitoring method in long-term follow-up of patients with Kawasaki disease.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Coronary Artery Disease , Diagnostic Imaging , Coronary Vessels , Pathology , Mucocutaneous Lymph Node Syndrome , Diagnostic Imaging , Tomography, Spiral ComputedABSTRACT
<p><b>OBJECTIVE</b>The underlying mechanisms for cardiac dysfunction in sepsis include the inhibitory effect of endotoxin and inflammatory factors on myocardium and the decrease in cardiac myocardial cells in number. However, whether there is ventricular remodeling resulted from the abnormalities of extracellular collagen metabolism and whether glutamine (Gln) can protect myocardium from LPS-induced damage as in reperfusion are unknown. The aim of the present study was to examine the effects of Gln on the expressions of matrix metalloproteinase-3 (MMP-3), tissue inhibitor of metalloproteinase-3 (TIMP-3) and their mRNA in myocardium of rats with sepsis.</p><p><b>METHODS</b>Classical rat model of sepsis was established by intraperitoneal injection of lipopolysaccharide (LPS) (4 mg/kg, from Escherichia coli O(55): B(5), Sigma). from 121 Wistar rats aged 18 days were divided into three groups randomly, 0 h control group (normal saline: 1 ml/kg, n = 11), LPS group (LPS: 4 mg/kg, n = 55) and Gln group (LPS: 4 mg/kg and immediately 13.64% glutamine 1 ml/kg, Fresenus, n = 55). Furthermore, LPS and Gln groups were examined at 2 h, 4 h, 6 h, 24 h and 72 h time points (n = 11). On each time point, rats of LPS and Gln groups as well as control group were anesthetized with 1% chloral hydrate injected intraperitoneally at a dosage of 1 ml/kg. Then, rats were sacrificed, and the hearts were isolated. Eight of them were frozen at minus 80 degrees C to measure the expression of TIMP-3 mRNA by using RT-PCR. The expressions of MMP-3 and TIMP-3 were observed with immunohistochemistry and the expression of MMP-3 mRNA was observed by using in situ hybridization.</p><p><b>RESULTS</b>(1) Compared to 0 h, the mRNA expressions of MMP-3 and TIMP-3 in LPS group significantly increased (P < 0.01) with the peak at 6 - 24 h. While, in Gln group, they were significantly higher than those in controls but significantly lower than those in LPS group with the peak at 24 h (P < 0.01). Even at 72 h, they were still higher than those at 0 h (P < 0.05 and P < 0.01). (2) Compared to 0 h, the expressions of MMP-3 and TIMP-3 in LPS group were significantly lower at any other time point with the lowest at 6 h (P < 0.01). In Gln group, these expressions were also significantly lower than those in controls, but significantly higher than those in LPS group with the lowest being postponed to 24 h (P < 0.01). (3) The ultra structure changed obviously. Z line was unclear and the ridge of mitochondrion disappeared. While, in Gln group, the myocardial injury was slight compared to that in LPS group.</p><p><b>CONCLUSIONS</b>MMP-3 mRNA expression was increased and TIMP-3 mRNA expression was depressed in LPS-induced sepsis. Myocardial extracellular matrix was damaged in sepsis. Glutamine might decrease the effects of LPS on MMP-3 and TIMP-3 expressions and postpone the time of myocardial matrix injury.</p>
Subject(s)
Animals , Female , Male , Rats , Animals, Newborn , Disease Models, Animal , Glutamine , Pharmacology , Immunohistochemistry , In Situ Hybridization , Lipopolysaccharides , Toxicity , Matrix Metalloproteinase 3 , Metabolism , Myocardium , Cell Biology , Metabolism , Myocytes, Cardiac , Metabolism , RNA, Messenger , Rats, Wistar , Reverse Transcriptase Polymerase Chain Reaction , Sepsis , Drug Therapy , Genetics , Metabolism , Time Factors , Tissue Inhibitor of Metalloproteinase-3 , MetabolismABSTRACT
0.05).Three coronary artery aneurysm in the distal RCA was missed by 2DE.MSCT could not detect slight or moderate mitral regurgitation in 2 patients and artery wall thickening in 5 patients.Conclusion MSCT would be an effective complementary or alternative method for CDEC to evaluate coronary artery lesions non-invasively in pediatric patients with Kawasaki disease.