Division of Infectious Diseases and Immunology and Allergy, Saitama Children's Medical Center, Saitama, Japan.
Department of Cardiology, Tokyo Metropolitan Children's Medical Center, 2-18-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
Eur J Pediatr. 2024 Nov;183(11):4817-4825. doi: 10.1007/s00431-024-05765-3. Epub 2024 Sep 6.
This study is to investigate whether angiotensin type 1 receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEis) can regress coronary artery aneurysm (CAA) in patients with Kawasaki disease (KD).
This multicenter, prospective, observational study was conducted at 53 institutions throughout Japan. We enrolled patients who were diagnosed with KD after January 2015 and had a medium or large CAA (maximum luminal diameter ≥ 4 mm or z score ≥ + 5) 30 days or later after KD onset.
Of the 209 patients, 47 (22%) were taking ARBs/ ACEis. Compared with those in the non-ARB/ACEi group, the baseline CAA diameter was significantly greater (6.7 mm vs. 5.5 mm, p < 0.01), and bilateral CAA (70% vs. 59%, p = 0.01) and giant CAA (32% vs. 20%, p = 0.08) were more frequently observed in the ARB/ACEi group. Although the overall regression rates did not differ between the groups (67% vs. 65%), the regression rates of giant CAA were approximately 1.6 times greater in the ARB/ACEi group than in the non-ARB/ACEi group (36% vs. 23%). Multivariate Cox regression analysis after adjustment for other clinical variables suggested that ARBs/ACEis may be a factor in CAA regression (hazard ratio [HR]: 1.5, 95% confidence interval [CI]: 0.91-2.46).
Although ARBs/ ACEis were used more frequently in patients with severe CAA, these patients had similar CAA regression rates to patients not taking ARBs/ACEis. ARBs/ACEis may be beneficial agents aimed at inducing CAA regression in KD patients.
• Large CAAs are less likely to regress and are always at risk of life-threatening cardiac events. • Moderate CAA, age less than 1 year, and female sex have been reported to be factors that promote the regression of CAA.
• Although ARBs/ACEis were used more frequently in patients with severe CAA, these patients had a similar rate of CAA regression to patients who did not take ARBs/ACEis. • The regression rates of giant CAA were approximately 1.6 times greater in the ARB/ACEi group than in the non-ARB/ACEi group.
本研究旨在探讨血管紧张素受体阻滞剂（ARB）或血管紧张素转换酶抑制剂（ACEI）是否可使川崎病（KD）患者的冠状动脉瘤（CAA）消退。
这项多中心、前瞻性、观察性研究在日本 53 家机构进行。我们招募了 2015 年 1 月以后被诊断为 KD 且发病 30 天后存在中或大 CAA（最大管腔直径≥4mm 或 z 评分≥+5）的患者。
在 209 例患者中，47 例（22%）正在服用 ARB/ACEI。与非 ARB/ACEI 组相比，ARB/ACEI 组的基线 CAA 直径明显更大（6.7mm 比 5.5mm，p<0.01），双侧 CAA（70%比 59%，p=0.01）和巨大 CAA（32%比 20%，p=0.08）更为常见。尽管两组的总体消退率无差异（67%比 65%），但 ARB/ACEI 组的巨大 CAA消退率约为非 ARB/ACEI 组的 1.6 倍（36%比 23%）。多变量 Cox 回归分析校正其他临床变量后提示，ARB/ACEI 可能是 CAA 消退的一个因素（风险比[HR]：1.5，95%置信区间[CI]：0.91-2.46）。
尽管 ARB/ACEI 在严重 CAA 患者中更为常用，但这些患者的 CAA 消退率与未服用 ARB/ACEI 的患者相似。ARB/ACEI 可能是一种有助于 KD 患者诱导 CAA 消退的药物。
• 大 CAA 不太可能消退，始终存在危及生命的心脏事件风险。• 已有研究报道中等 CAA、年龄<1 岁和女性是促进 CAA 消退的因素。
• 尽管 ARB/ACEI 在严重 CAA 患者中更为常用，但这些患者的 CAA 消退率与未服用 ARB/ACEI 的患者相似。• ARB/ACEI 组的巨大 CAA 消退率约为非 ARB/ACEI 组的 1.6 倍。
