不同年龄不完全川崎病患儿血管内皮功能特点及其与冠状动脉损伤的关系  

Characteristics of vascular endothelial function and its relationship with coronary artery injury in children with incomplete Kawasaki disease of different ages

作　　者：刘瑞花 李建伟[1] 范允宁 孙广斐 王艺璇 Liu Ruihua;Li Jianwei;Fan Yunning;Sun Guangfei;Wang Yixuan(Department of Pediatrics,Affiliated Hospital of Jining Medical University,Shandong Provincial Key Medical and Health Discipline of Pediatric Internal Medicine,Jining Key Laboratory for Prevention and Treatment of Severe Infection in Children,Jining 272000,China;Jining Institute of Quality Measurement and Testing,Jining 272000,China)

机构地区：[1]济宁医学院附属医院儿科,山东省医药卫生儿科内科学重点学科,济宁市儿童重症感染防治重点实验室,济宁272000 [2]济宁市质量计量检验检测研究院,济宁272000

出　　处：《中国医师杂志》2024年第8期1151-1156,共6页Journal of Chinese Physician

基　　金：国家自然科学基金(81700702)。

摘　　要：目的探讨不同年龄不完全川崎病(IKD)患儿血管内皮功能特点及其与冠状动脉损伤(CAL)的关系。方法选择2020年2月至2022年5月济宁医学院附属医院收治的200例IKD患儿纳入IKD组,另选取同期进行体检的200例健康儿童纳入对照组。根据IKD患儿年龄,<1岁患儿为婴儿组(n=78)、1~3岁患儿为幼儿组(n=62)、>3~6岁患儿为学龄前期组(n=60),分析比较不同年龄段的IKD患儿及正常对照组儿童的血管内皮功能特点。另外根据是否合并CAL将IKD患儿分为CAL组(n=110)和n-CAL组(n=90),比较两组患者年龄、颈动脉内膜中层厚度(IMT)、内皮依赖性舒张功能(FMD)、颈动脉僵硬度指数(SI)、内皮非依赖性舒张功能(NMD)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、肱动脉内皮依赖性扩张功能(EDD)等临床资料。采用Cox比例风险模型行单因素和多因素分析,明确IKD患儿发生CAL的风险因素,构建列线图预测模型并进行模型评价。结果IKD患儿与正常对照组儿童FMD、NMD、SI、IMT、反应性充血指数(RHI)以及EDD比较差异均有统计学意义(均P<0.05)。三组不同年龄的IKD患儿FMD、NMD、SI、IMT、RHI以及EDD差异均有统计学意义(均P<0.05)。n-CAL组与CAL组患儿在年龄≤3岁占比、TNF-α、CRP、SI、IMT、EDD、FMD以及NMD方面差异均有统计学意义(均P<0.05)。年龄≤3岁,TNF-α、CRP、SI、IMT以及EDD升高,FMD以及NMD降低,均为IKD患儿发生CAL的独立危险因素(均P<0.05)。列线图预测模型区分度较高,预测IKD患儿发生CAL的曲线下面积为0.868、0.830。结论不同年龄的IKD患儿血管内皮功能存在显著差异,血管内皮功能与CAL的发生密切相关,当血管内皮功能出现异常时,易发生CAL。ObjectiveTo explore the characteristics of endothelial function in children with incomplete Kawasaki disease(IKD)of different ages and its relationship with coronary artery lesion(CAL).MethodsA total of 200 children with IKD admitted to the Affiliated Hospital of Jining Medical University from February 2020 to May 2022 were selected as the IKD group,and another 200 healthy children who underwent physical examinations during the same period were selected as the control group.According to the age of children with IKD,infants(n=78)were classified as those under 1 year old,infants(n=62)were classified as those between 1-3 years old,and preschool children(n=60)were classified as those over 3-6 years old.The endothelial function characteristics of IKD children in different age groups and normal control group children were analyzed and compared.In addition,IKD patients were divided into CAL group(n=110)and nCAL group(n=90)based on whether CAL was merged.The age,carotid intima-media thickness(IMT),flow-mediated-dilation(FMD),carotid stiffness index(SI),nitroglycerin-mediated dilation(NMD),tumor necrosis factorα(TNF-α),C-reactive protein(CRP),brachial artery endothelial dependent dilation function(EDD)and other clinical data were compared between the two groups.Cox proportional hazards model was used for univariate and multivariate analysis to identify the risk factors for CAL in IKD patients.A column chart prediction model was constructed and evaluated.ResultsThere were statistically significant differences in FMD,NMD,SI,IMT,reactive congestion index(RHI),and EDD between IKD patients and normal control group children(all P<0.05).There were statistically significant differences in FMD,NMD,SI,IMT,RHI,and EDD among three groups of IKD children of different ages(all P<0.05).There were statistically significant differences in the proportion of children aged≤3 years,TNF-α,CRP,SI,IMT,EDD,FMD,and NMD between the nCAL and CAL groups(all P<0.05).Age≤3 years,elevated levels of TNF-α,CRP,SI,IMT,and EDD,as well as decreased l

关 键 词：年龄 不完全川崎病 血管内皮功能 冠状动脉损伤 

分 类 号：R725.4[医药卫生—儿科]