Gupta Anand, Singh Surjit, Gupta Anju, Suri Deepti, Rohit Manojkumar
Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Rheumatol Int. 2014 Oct;34(10):1427-32. doi: 10.1007/s00296-014-3000-8. Epub 2014 Apr 3.
Kawasaki disease (KD) is an acute medium vessel vasculitis seen in children. Coronary artery abnormalities are the most notable long-term complications. Intravenous immunoglobulin therapy has led to significant reduction in incidence of coronary aneurysms. However, higher risk of cardiovascular disease has been noted even in those children who have never been reported to develop coronary artery aneurysms during the subacute phase. Noninvasive estimation of this cardiovascular risk is useful in initiating timely preventive strategies. Arterial stiffness has been shown to be an independent predictor of cardiovascular events in general population. This study was aimed at measuring abdominal aorta stiffness in a cohort of children with KD from North India. Thirty children diagnosed to have KD at least 5 years prior to enrollment were evaluated by echocardiography for cardiac and abdominal aorta studies. Electrocardiographs were done in all patients for QT dispersion. There was a noticeable trend toward lower aortic strain, higher pressure strain elastic modulus and normalized pressure strain elastic modulus in children in the study group, though this difference did not reach statistical significance. Mean corrected QT dispersion was significantly higher in cases compared with controls. On cardiac evaluation, none of the subjects had any residual coronary artery involvement. A trend toward lower distensibility and higher stiffness of abdominal aorta was seen in cases compared with controls, though it was not found to be statistically significant. This could be a predictor of premature atherosclerosis in long term. Significantly higher QT dispersion was seen in cases compared with controls. More multicentric studies with larger sample size and longer follow-up periods are needed to clarify this issue.
川崎病（KD）是一种在儿童中出现的急性中等血管血管炎。冠状动脉异常是最显著的长期并发症。静脉注射免疫球蛋白治疗已使冠状动脉瘤的发生率显著降低。然而，即使在那些亚急性期从未被报告发生冠状动脉瘤的儿童中，也已注意到心血管疾病风险较高。对这种心血管风险进行非侵入性评估有助于及时启动预防策略。一般人群中，动脉僵硬度已被证明是心血管事件的独立预测指标。本研究旨在测量印度北部一组川崎病患儿的腹主动脉僵硬度。对入组前至少5年被诊断为川崎病的30名儿童进行超声心动图检查，以研究心脏和腹主动脉。所有患者均进行心电图检查以测量QT离散度。研究组儿童的主动脉应变较低、压力应变弹性模量和标准化压力应变弹性模量较高，虽有明显趋势，但这种差异未达到统计学意义。与对照组相比，病例组的平均校正QT离散度显著更高。心脏评估显示，所有受试者均无残余冠状动脉受累。与对照组相比，病例组腹主动脉的可扩张性较低且僵硬度较高，虽有此趋势，但未发现具有统计学意义。从长期来看，这可能是过早发生动脉粥样硬化的一个预测指标。与对照组相比，病例组的QT离散度显著更高。需要更多样本量更大、随访期更长的多中心研究来阐明这一问题。
