Zheng Jianbo, Nakamura Tsuneyuki, Lu Na, Hori Kaori, Oguri Masato, Sakurai Masaru, Ishizaki Masao
Department of Pediatric Cardiology, Kanazawa Medical University, Ishikawa, Japan.
Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Ther Clin Risk Manag. 2019 Jun 12;15:701-709. doi: 10.2147/TCRM.S208632. eCollection 2019.
We recently reported that children and adolescents with a history of Kawasaki disease (KD) had slight but significant elastic arterial stiffness even when no coronary artery lesions (CALs) were present. Moreover, we hypothesized that KD-related arteriopathy may also cause peripheral artery dysfunction. The objective of this study was to assess the involvement of radial artery pulse waves, especially reflection waves from the peripheral arteries using the radial artery augmentation index (rAI) in patients without CALs after KD.
We first collected the rAI data from 312 subjects (149 consecutive patients of KD and 163 control subjects). Next, 225 cases between 6 and 15 years old were selected. Finally, 41 pairs were included for analysis. The rAI values of these two groups were compared and analyzed. Acute-phase data were also collected to reveal the possible correlation with rAI in the convalescent period.
Multivariable analysis revealed the history of KD was positively correlated with rAI@75 value in children from 6 to 15 years old. After pairing the height and gender, the KD group also had significantly higher rAI and rAI@75 than the control group (rAI 60.63±13.77 vs 54.56±13.17, =0.028; rAI@75 63.61±15.21 vs 55.68±14.86, =0.003). With regard to acute-phase condition, nonresponse to initial treatment was also linked to elevated rAI during the convalescent period.
During the convalescent period, the rAI increased in KD patients without acute CALs. Furthermore, nonresponse to initial treatment in acute phase conferred higher rAI to KD subjects than respondent cases. Elevated rAI means the reflection wave from the peripheral vascular is stronger or earlier. This small but significant change may indicate the existence of peripheral artery stiffness during the convalescent period.
我们最近报道，即使没有冠状动脉病变（CALs），有川崎病（KD）病史的儿童和青少年也存在轻微但显著的弹性动脉僵硬。此外，我们推测KD相关的动脉病变也可能导致外周动脉功能障碍。本研究的目的是评估KD后无CALs患者桡动脉脉搏波的情况，特别是使用桡动脉增强指数（rAI）评估来自外周动脉的反射波。
我们首先收集了312名受试者（149例连续的KD患者和163名对照受试者）的rAI数据。接下来，选择了225例6至15岁的病例。最后，纳入41对进行分析。比较并分析了这两组的rAI值。还收集了急性期数据以揭示其与恢复期rAI的可能相关性。
多变量分析显示，KD病史与6至15岁儿童的rAI@75值呈正相关。在匹配身高和性别后，KD组的rAI和rAI@75也显著高于对照组（rAI 60.63±13.77 vs 54.56±13.17，P = 0.028；rAI@75 63.61±15.21 vs 55.68±14.86，P = 0.003）。关于急性期情况，对初始治疗无反应也与恢复期rAI升高有关。
在恢复期，无急性CALs的KD患者rAI升高。此外，急性期对初始治疗无反应的KD受试者的rAI高于有反应的病例。rAI升高意味着来自外周血管的反射波更强或更早。这种微小但显著的变化可能表明恢复期存在外周动脉僵硬。
