Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
Sci Rep. 2019 Nov 13;9(1):16714. doi: 10.1038/s41598-019-53220-3.
About a quarter of children with new onset of Kawasaki disease (KD) encounter coronary arterial involvement. While KD is known to cause vasculitis of medium-sized vessels, few studies have been done to study the involvement of the microcirculation. We aimed to investigate the association between coronary arterial dilatation and retinal microvasculature in a pilot setting, in order to further study the pathophysiological mechanism of KD from the perspective of small vessels changes. We performed a cross-sectional, observational, hospital-based study on 11 children aged 2 years and above with new-onset KD. Cardiac imaging technicians performed the echocardiographic examinations and recorded right coronary artery (RCA), left coronary artery (LCA) and left anterior descending artery (LAD). Qualified retinal graders reviewed and graded standardised retinal photographs to assess retinal microvascular parameters. Among 11 participants, there were 7 boys and 4 girls. Median and interquartile range of participants' age were 5.92 (3.08) years. After adjusting for age and sex, each unit increase in LAD (mm) was significantly associated with increment of retinal arteriolar tortuosity (4.25 × 10 units, 95% Confidence Interval: 1.19, 7.32). Retinal arteriolar geometric changes were associated with LAD dilatation in 11 children with new onset of KD. Our pilot provided proof-of-concept that retinal imaging might be useful for detecting coronary arterial involvement in young children with KD and it needs further investigation.
约四分之一新发川崎病（KD）患儿会出现冠状动脉受累。尽管已知 KD 会引起中等大小血管的血管炎，但很少有研究探讨微循环的受累情况。我们旨在初步研究中探讨冠状动脉扩张与视网膜微血管之间的关联，以便从小血管变化的角度进一步研究 KD 的病理生理机制。我们对 11 名年龄在 2 岁及以上新发 KD 的患儿进行了横断面、观察性、基于医院的研究。心脏影像技术人员进行了超声心动图检查，并记录了右冠状动脉（RCA）、左冠状动脉（LCA）和左前降支（LAD）。合格的视网膜分级员审查并分级标准化视网膜照片，以评估视网膜微血管参数。在 11 名参与者中，有 7 名男孩和 4 名女孩。参与者的年龄中位数和四分位数间距为 5.92（3.08）岁。在校正年龄和性别后，LAD（mm）每增加一个单位，视网膜小动脉迂曲度显著增加（4.25×10 单位，95%置信区间：1.19，7.32）。11 名新发 KD 患儿的视网膜小动脉几何变化与 LAD 扩张相关。我们的初步研究提供了概念验证，即视网膜成像可能有助于检测患有 KD 的幼儿的冠状动脉受累情况，这需要进一步研究。
