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Long-term antiplatelet therapy is critical for children with Kawasaki disease.Commonly used antiplatelet drugs have their own advantages and adverse reactions, so they need to be chosen carefully.Some studies have shown that drug resistance may occur in children with Kawasaki disease during antiplatelet therapy, which increases the risk of cardiovascular adverse events, and platelet aggregation function needs to be monitored during medication.This paper reviews the antiplatelet drugs in common use, the drug resistance of antiplatelet drugs and the detection methods of platelet aggregation function in Kawasaki disease, which is helpful to improve the safety of drugs use and reduce the incidence of complications in children.
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Objective:To analyse the association between triglyceride glucose (TyG) index and the number of coronary artery lesions in patients with stable coronary artery disease.Methods:It was a cross-sectional study. Patients with stable coronary artery disease who were admitted to Zhongshan Hospital, Fudan University from 1st January 2019 to 30th April 2020 for percutaneous coronary intervention (PCI) were selected. We collected general clinical information and laboratory results from the enrolled patients, then calculated the TyG index. We evaluated coronary artery lesions by coronary angiography and analysed the factors associated with the number of coronary artery lesion branches by the logistic regression model.Results:A total of 832 patients were included in this study, 641 (77.0%) were male, the age was (64.6±11.5) years. The mean TyG index was 8.78. Patients with the TyG index≥8.78 were included in the high TyG index group (411 patients), and those with the TyG index<8.78 were included in the low TyG index group (421 patients). Compared with the low TyG index group, the high TyG index group had the higher body mass index and diastolic blood pressure, more smokers and diabetes mellitus, younger age of onset of coronary heart disease (all P<0.05), and a lower proportion of patients using statins ( P=0.027). Compared with the low TyG index group, the high TyG index group had the higher levels of erythrocyte count, hemoglobin, white blood cell count, albumin, urea nitrogen, uric acid, fasting blood glucose, HbA1c, triglyceride, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, apolipoprotein E, and C-reactive protein (all P<0.05). However, the levels of high density lipoprotein, apolipoprotein A1 and apolipoprotein A were lower in the high TyG index group than those in the low TyG index group (all P<0.05). The number of coronary artery lesions in patients in the high TyG index group was 2.35±0.91, more than the low TyG index group 2.10±0.95 ( P<0.001).After adjusting for the other factors, multivariate logistic regression analysis showed that male, smoking history (smoking cessation or smoking), TyG index and troponin T levels were independently positively associated with the number of coronary artery lesions (all OR>1, P<0.05), while ApoA1 was independently negatively associated with the number of coronary artery lesions ( OR=0.140, P=0.007). Conclusions:TyG index is positively associated with the number of coronary artery lesions in patients with stable coronary artery disease.
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Kawasaki disease is an acute febrile systemic vasculitis of unknown etiology that mainly occurs in children under 5 years of age.Coronary artery lesions caused by Kawasaki disease has become one of the common acquired cardiovascular diseases in childhood.The degree of coronary artery lesions determines the prognosis and follow-up management of Kawasaki disease.The use of anticoagulant and antiplatelet drugs is the basis for the treatment of coronary artery disease in Kawasaki disease, while non-pharmacological treatment is another treatment for severe coronary artery lesions and ineffective drug therapy.This paper reviews the research progress of non-pharmacological treatment for coronary artery lesions of Kawasaki disease, providing new ideas for comprehensive and alternative treatment of the disease.
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Coronary artery lesions are the most serious complications of Kawasaki disease.The incidence of Kawasaki disease is still on the rise in recent years, and the proportion of children with coronary artery dilatation increased in parallel with the incidence of Kawasaki disease.But the incidence of severe coronary artery lesions, such as giant coronary aneurysms, coronary artery stenosis and even occlusion is stable or declining.The pathological changes of coronary artery disease are different with the severity and duration of the disease.Early recognition of coronary artery lesions should not be limited to the observation of luminal dimensions, but also should be explored in depth about the changes of coronary artery structure and function.
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Kawasaki disease is a nonspecific systemic vasculitis of unknown etiology which mainly involves small and medium arteries.The most serious complication is coronary artery lesions, which can lead to serious cardiovascular events.Because of the unknown etiology and pathogenesis, the acute pathological changes and long-term evolution of coronary artery lesions are particularly important for clinical diagnosis, treatment and long-term management.This article reviews the research progress of coronary artery pathology in Kawasaki disease and the long-term prognosis of coronary artery lesions.
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Coronary artery lesions caused by Kawasaki disease has become the most common cause of acquired heart disease in children, and it is also a key factor affecting the prognosis of Kawasaki disease.The Subspecialty Group of Cardiology, the Society of Pediatrics, Chinese Medical Association has issued an update "Recommendations for clinical management of Kawasaki disease with coronary artery lesions (2020 revision)" . Combining the latest clinical guidelines in China and related researches at domestic and abroad in recent years, the current status of diagnosis and treatments of coronary artery lesions caused by Kawasaki disease is summarized as follows.
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OBJECTIVE@#To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery.@*METHODS@#Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD).@*RESULTS@#There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up.@*CONCLUSION@#The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.
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Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Coronary Artery Disease/surgery , Feasibility Studies , Follow-Up Studies , Retrospective Studies , Stroke Volume , Treatment Outcome , Ventricular Function, LeftABSTRACT
Objective@#To explore the mediation mechanism of coronary artery lesion among both male and female Kawasaki disease (KD) children.@*Methods@#Children with KD that hospitalized in the Wenzhou Medical University affiliated Yuying Children’s Hospital from January 2009 to December 2014, were included in this study. Differences on demographical characteristics, clinical manifestations, laboratory indicators, regimen and time of treatment, results from pre/post echocardiography and treatment between male and female patients, were compared. The independent effect of gender on the risk of coronary artery lesions (CAL) was evaluated, and the mediating effect of BMI, visiting time and KD type on the association between gender and CAL were also studied.@*Results@#The average BMI level of male patients was higher than that of female patients. The difference was statistically significant (P<0.001). The prevalence of overweight among male patients (20.9%) was higher than female (14.1%). The difference was statistically significant (P=0.011). Data from the multivariate logistic regression analysis confirmed that the incidence of CAL in male patients was higher than that in female patients (aOR=1.50, 95%CI: 1.06-2.12) but the CAL was mainly different before on the immunoglobulin therapy. Results from the mediation analysis showed that BMI was an important mediator in the association between gender and CAL, with the indirect effect as 1.05 (95%CI: 1.01- 1.10) and the proportion mediated as 13.0%.@*Conclusions@#Male patients presented higher incidence of CAL but was mainly reflected in the difference of CAL before the treatment. BMI was probably an important mediator related to the association between gender and CAL.
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Objective:To investigate association between the single nucleotide polymorphisms of endothelial protein C receptor (EPCR) gene and the risk of Kawasaki disease (KD) in a Chinese children.Methods:A total of 103 KD patients including 23 patients with coronary artery lesions (CAL) and 158 controls were recruited.Seven tagging SNPs (rs6088738,rs2069940,rs2069945,rs2069952,rs867186,rs9574,and rs1415774) of EPCR gene were selected for TaqMan allelic discrimination assay.The plasma soluble EPCR (sEPCR) levels of 53 KD and 52 healthy children were detected by ELISA.Results:We found a significant association between rs2069952,rs9574 or rs1415774 and higher probability for the occurrence of KD but not CAL formation.Interestingly,males with these 3 SNPs and rs2069945 SNPs bore a much greater risk of KD than females.The level of plasma sEPCR in children with KD didnot predict the formation of CAL.However,the allele G of rs867186 in EPCR was associated with the increased level of plasma sEPCR in KD patients.Conclusion:The SNPs of EPCR are associated with KD susceptibility in a Chinese Han children.
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Kawasaki disease (KD) is an acute systemic small and medium vasculitis syndrome,which is most commonly found in children under the age of 5 years.The most severe complications of KD are coronary artery lesions (CAL),which will lead to coronary artery dilatation,myocardial infarction and sudden death.In the acute stage,severe clinical manifestations are associated with shock,and all organs could be involved,which is called severe Kawasaki disease (SKD),sometimes requiring treatment in the pediatric intensive care unit (PICU) have been reported.Although the clinical symptoms of children with SKD are severe,most patients can survive without any sequelae as long as they can be diagnosed accurately and treated rapidly.In recent years,scholars at home and abroad have paid more and more attention to SKD.Based on these,we take SKD as the research object,try to explain the progress of clinical diagnosis and treatment,which is beneficial to pediatric clinicians to accurately judge and treat related diseases.
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Objective To investigate the significances of PAMP and NT-proBNP in predicting coronary artery injury in Kawasaki disease(KD).Methods A total of 196 cases of KD in this hospital from February 2014 to August 2015 were selected and divided into the KD injury group and KD non-injury group according to with orwithout coronary arterial injury.Contemporaneous 50 healthy children in the Child Health Care Center were selected as the control group.The plasma levels of PAMP and NT-proBNP were detected in 3 groups.Results Compared with the control group,the plasma levels of PAMP and NT-proBNP in the childrenpatients with KD were increased,moreover the KD injury group was higher than the KD non-injury group(P＜0.05).The plasma PAMP levels in KD children patients were positively correlated with NT-proBNP,white blood cell(WBC) count,neutrophil percentage and erythrocyte sedimentation rate(ESR)(P＜0.05),while were negatively correlated with the value of serum sodium and albumin(P＜0.05),the plasma levels of NT-proBNP were positively correlated white blood cell count,neutrophil percentage,C-reactive protein(CRP) and ESR(P＜0.05),while were negatively correlated with the levels of serum sodium and albumin(P＜0.05).The area under the curve(AUC) of plasma PAMP and NT-proBNP levels in predicting coronary artery damage in children patients with KD was 0.989,the sensitivity was 93.24％ and specificity was 93.65 ％.Conclusion The plasma levels of PAMP and NT-proBNP in children patients with acute phase of KD are elevated,which can serve as the predictive indicators of coronary artery lesion.
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Objective To explore the clinical value of Z score in assessing coronary artery lesions (CAL) of children with Kawasaki disease. Methods The clinical records of 102 children with Kawasaki disease from January 2012 to December 2016 in Gansu Provincial Hospital were retrospectively analyzed. The internal diameter of left main coronary artery (LMCA) and right coronary artery ( RCA) was measured by echocardiography (ECHO),and the incidence of CAL was preliminarily judged. The Z scores of LMCA and RCA were calculated on the basis of the coronary artery diameter,the age of the children and the body surface area,and the incidence of CAL was judged again. Results A total of 22 cases(21. 6%) of CAL were found in 102 cases by ECHO examination,of which 18 cases(17. 6%) of LMCA lesions,and 22 cases(21. 6%) of RCA lesions. A total of 33 cases(32. 4%) of CAL were found by calculating the Z score of coronary artery, of which 29 cases(28. 4%) of LMCA lesions and 33 cases(32. 4%) of RCA lesions. There was significant difference between two methods for determining LMCA lesions (χ2=3. 35,P＜0. 05),and there was no sig-nificant difference between two methods for determining RCA lesions (χ2=3. 01,P＞0. 05). Z score of coro-nary artery was more accurate to detect the CAL in Kawasaki disease,especially LMCA lesions. A large coro-nary artery aneurysm was found in the patients with the largest Z score by selective coronary angiography. Conclusion The Z score can be more conductive to assess the CAL in children with Kawasaki disease,and the higher the Z score,the more serious the CAL is.
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Objective To investigate the relationship between nuclear factor kappa B(NF-κB) and matrix metalloproteinase-9 (MMP-9) mRNA in human umbilical vein endothelial cells(HUVECs) stimulated by the serum from children with coronary artery lesions of Kawasaki disease (KD).Methods HUVECs were cultured and were divided into 4 groups:normal serum group,general fever group,Non-CALs group and CALs group.Co-Immunoprecipitation (ChIP) was used to detect the relationship between NF-κB and MMP-9,and RT-PCR was used to detect the mRNA level of MMP-9.Results Compared with control groups,NF-κB p65 could bind the promoter of MMP 9 in HUVECs cultured with 10 ％ serum from KD patients with coronary artery lesions.The mRNA level of MMP 9 was also up-regulated.Conclusion NF-κB p65 can promote the transcription of MMP-9 in HUVECs induced by the serum from KD patients with coronary artery lesions.
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Objective To investigate the acute phase expression of serum cytokines in children with Kawasaki disease (KD) and its association with coronary artery lesions (CALs). Methods Expression of 13 cytokines in serum of 104 KD patients including 11 cases with CALs and 74 febrile control cases admitted to the hospital from October 2016 to March 2017 were retrospectively analyzed. Results Interleukin (IL)-8, IL-1, IL-2, IL-6, IL-10, IL-17A, IL-18, tumor necrotic factor-α and SCD25 (IL-2R) were declined significantly after intravenous immunoglobulin administration (IVIG) in KD patients (all P<0.05). Compared with the fever control group, Pre-IVIG, an IL-17A level ≥ 0.155 pg/mL had a sensitivity of 50% and 93.2% specificity for predicting KD; IL-18 level ≤ 15.43 pg/mL had a sensitivity of 71.2%, and the specificity was 54.1%; SCD25 (IL-2R) ≥ 29475.29 pg/mL had a 65.4% sensitivity and 81.1% specificity for predicting KD. Before IVIG treatment, the level of IL-10 was significantly lower in KD patients with CALs than in those without CALs. Conclusions Determination of various cytokines profile may be helpful for predicting the disease prognosis and targeting treatment strategies in patients with KD.
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Objective To investigate the changes of heart rate deceleration capacity(DC)in patients with unstable angina pectoris(UAP)and its correlation with the scope and severity of coronary artery disease. Methods From September 2016 to January 2017,one hundred and nine patients with UAP and 52 with non-coronary artery disease were diagnosed in the department of cardiology in the Third Affiliated Hospital of Anhui Medical University. They were all measured with 24h dynamic electrocardiogram and the corresponding analysis software was used to analyze the results,and the difference in deceleration capacity between the two groups was compared. The severity and the number of coronary artery lesions were compared with different deceleration capacity in UAP patients. The relationship between deceleration capacity and the number of coronary artery stenosis, the scope and severity of coronary artery lesions were then analyzed. Results The deceleration capacity value of UAP group was significantly lower than that of the control group((5.10 ± 1.34)vs.(6.03 ±1.40),t=-3.775,P<0.01). The number of coronary artery lesions and Gensini score in group deceleration capacity>4.5 ms were smaller than those in group deceleration capacity ≤4.5 ms((1.67± 0.77)branches vs. (26.76±25.31)branches;(21.27±5.541)points vs.(42.69±8.61)points)(t= -3.910,-2.277,P<0.05). The deceleration capacity value was negatively correlated with the number of coronary artery stenosis(r=-0.206,P<0.01)and the Gensini score(r=-0.358, P<0.01)in patients with UAP. Conclusion Deceleration capacity decreased in patients with UAP and it was closely associated with the severity and the scope of coronary artery lesions.
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Objective To study the expression of plasma oxidized low-density lipoprotein (oxLDL) in children with acute phase Kawasaki disease (KD), and investigate its value for early prediction of coronary artery lesions in KD. Methods Totally 80 children with KD were collected. Children were divided into four groups by the results of echocardiogram of coronary artery in different periods: CAL1 group (children with coronary artery lesions (CAL+) both in acute and sub-acute phase, 8 cases), CAL2 group (children with CAL+in acute phase but recovery normal (CAL-) in sub-acute phase, 10 cases), NCAL1 group (children with CAL-in acute phase but occur CAL+ in sub-acute phase, 10 cases) and NCAL2 group (children with CAL- both in acute and sub-acute phase, 52 cases). The serum samples (before the use of intravenous immunoglobulin) were collected in acute phase. Twenty healthy controls and twenty fever controls were enrolled into the study, and their serum samples were collected. OxLDL was measured by enzyme linked immunosorbent assay (ELISA). They were compared using ANOVA, pairwise comparison LSD-t test. And ROC curve analysis was used to determine the threshold. Results Compared with the control groups,plasma oxLDL levels were higher in children with KD, both CA+and CAL-[(15.0±3.3) mU/L, (12.3±3.5) mU/L vs (9.2±2.2) mU/L, (8.0±2.3) mU/L, F=20.435, P<0.05]. Plasma oxLDL levels were increased more significantly in children with CAL+ than children with CAL- in KD [(15.0 ±3.3) mU/L vs (12.3 ±3.5) mU/L, t=2.28, P=0.002]. There was significant difference in the concentration of oxLDL between the groups of Kawasaki disease (F=5.068, P=0.003). Plasma oxLDL levels were significantly higher in the NCAL1 group than those in the NCAL2 group [(14.5 ±3.8) mU/L vs (11.9±3.3) mU/L, t=2.29, P=0.02], but there were no statistically significant difference between the NCAL1 group and CAL1 or CAL2 group [(14.5±3.8) mU/L vs (15.9±3.9) mU/L, (14.5±3.8) mU/L vs (14.2±2.7) mU/L, t=0.73, 0.20;P=0.41, 0.84]. ROCs analysis indicated that oxLDL≥13.83 mU/L, could be the threshold for the prediction of coronary artery lesions with the sensitivity of 0.607 and a specificity of 0.75. Conclusion OxLDL plays an important role in coronary artery lesions in KD. The coronary endothelial dysfunction is earlier than coronary dilatation, and oxLDL is expected to become a reliable early predictor of coronary artery lesions in KD.
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Objective To investigate the changes of serum 8-hydroxy-2'-deoxyguanosine(8-OHDG) in Kawasaki disease (KD) children and to explore the importance of 8-OHDG in predicting the severity of coronary artery lesions in Kawasaki Disease.Methods The serum 8-OHDG was measured in KD patients group (n =60),fever patients group (n =12) and health control group (n =12) by ELISA method.Among the KD patients,30 KD patients were in acute stage (10 cases had coronary artery lesions,20 coronary were normal) and 30 patients were in recovery stage.The serum 8-OHDG and brain natriuretic peptide (BNP) were also compared between patients with coronary artery lesions (CALs) and patients with no coronary artery lesions NCALs).ROC curve analysis was used to test the 8-OHDG and BNP predictive values in KD with coronary artery lesions.Results The serum level of 8-OHDG was higher in acute KD patients than recovery KD patients,fever patients and healthy children (P ＜ 0.05) The serum 8-OHDG was higer in CALs patients than the NCALs patients (P ＜ 0.05).The serum BNP was higer in CALs patients than the NCALs patients (P ＜ 0.01).Analysis of the ROC curve showed that serum 8-OHDG had a positive predictive value of 64.3％ and a negative predictive value of 93.8％for distinguishing KD with CALs from KD NCALs when cutoff value was 57.02pg/ml.The area under the curve was 0.820.The serum BNP had a a positive predictive value of 47.6％ and a negative predictive value of 100％ for distinguishing KD with CALs from KD NCALs when cutoff value was 815pg/ml.The area under the curve was 0.745.Conclusion The serum 8-OHDG may have better predictive value than BNP in diagnose KD children with coronary artery lesions.
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Kawasaki disease(KD)is an acute,self-limited and systemic vasculitis. The etiology and pathogenesis of KD still remain unclear.High-dose intravenous immunoglobulin(IVIG)combined with aspirin is the standard regimen of KD in acute stage,but the treatment of KD patients who were unresponsive to initial IVIG therapy still remains controversial.The main complication of KD is coronary artery lesions.Treatments of coronary artery lesions included antiplatelet,anticoagulant,thrombolytic therapy,percutaneous coronary interven-tions and coronary artery bypass grafting.In addition,follow-up and management of KD were also very impor-tant.
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Objective:To study the predictive value of carotid plaque score for evaluating the severity of coronary artery lesions.Methods:A total of 152 patients with coronary angiography diagnosed coronary artery disease (CAD) in our hospital from 2016-01 to 2016-05 were selected.According to coronary branch involvement,the patients were divided into 3 groups:Single branch lesion group,n=72,Double branch lesion group,n=38 and Multi branch lesion group,n=42.The basic conditions as plaque detection rate,high-density lipoprotein cholesterol (HDL-C),body mass index (BMI) were collected and carotid ultrasound examination was conducted in all patients.Carotid plaque condition and coronary lesion degree were calculated by semi-quantitative score and Gensini score methods;the relationship between semi-quantitative score and Gensini score was compared.Results:Total cholesterol (TC),HDL-C,LDL-C and BMI were similar among different groups,P＞0.05.Compared with Single branch lesion group,Double branch lesion group and Multi branch lesion group had more smokers and the higher plaque detection rate,P＜0.05.Semi-quantitative score and Gensini score were elevating as coronary lesion branch increasing accordingly.Conclusion:The severity of coronary lesions could be evaluated and predicted by semi-quantitative calculation of carotid integral.
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Objective:To study the predictive value of carotid plaque score for evaluating the severity of coronary artery lesions.Methods:A total of 152 patients with coronary angiography diagnosed coronary artery disease (CAD) in our hospital from 2016-01 to 2016-05 were selected.According to coronary branch involvement,the patients were divided into 3 groups:Single branch lesion group,n=72,Double branch lesion group,n=38 and Multi branch lesion group,n=42.The basic conditions as plaque detection rate,high-density lipoprotein cholesterol (HDL-C),body mass index (BMI) were collected and carotid ultrasound examination was conducted in all patients.Carotid plaque condition and coronary lesion degree were calculated by semi-quantitative score and Gensini score methods;the relationship between semi-quantitative score and Gensini score was compared.Results:Total cholesterol (TC),HDL-C,LDL-C and BMI were similar among different groups,P＞0.05.Compared with Single branch lesion group,Double branch lesion group and Multi branch lesion group had more smokers and the higher plaque detection rate,P＜0.05.Semi-quantitative score and Gensini score were elevating as coronary lesion branch increasing accordingly.Conclusion:The severity of coronary lesions could be evaluated and predicted by semi-quantitative calculation of carotid integral.