Zhou Jinhui, Ni Chao, Wang Zhenquan, Xia Yuhan, Shi Hongying, Zhao Xiaoshan, Chen Yufei, Liu Chenchen, Rong Xing, Wu Rongzhou, Chu Maoping, Qiu Huixian
Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; Zhejiang Provincial Clinical Research Center for Pediatric Disease, Wenzhou Medical University, Zhejiang, China.
Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou 325035, Zhejiang, China.
Microvasc Res. 2025 Jul;160:104817. doi: 10.1016/j.mvr.2025.104817. Epub 2025 May 7.
Kawasaki disease (KD) is an acute systemic inflammation, that affects medium-sized arteries. Coronary artery lesions (CALs) were the most serious complication or sequelae of KD. The intense inflammatory response leads to platelet activation, further exacerbating inflammation, which plays an important role in the pathogenesis of CALs in KD patients. Plus, coagulation factors are closely related to platelet activation. Therefore, we speculate that the activated partial thromboplastin time (APTT), an indicator of coagulation factor function, may be involved in the occurrence of CALs, but it has not been explored yet. This study aims to investigate the effect of the APTT level on CALs occurrence in the acute phase of KD.
A total of 2303 KD patients during a 10-year period were recruited at the Wenzhou Medical University affiliated Yuying Children's Hospital. A total of 1715 patients who completed the follow-up were enrolled in the final analysis and were divided into the low APTT group and the high APTT group at a 46 s cutoff before receiving intravenous immunoglobulin (IVIG) treatment. Multiple logistic regression analysis and stratified analysis were utilized to evaluate the independent impact of APTT levels on the occurrence of CALs and to determine the impact of APTT levels on the occurrence of CALs in different subgroups, respectively.
The incidence of CALs in the low APTT group and the high APTT group was 12.5 % and 17.5 %, respectively (P = 0.005). Patients with high APTT levels had higher CRP levels (P < 0.001). High APTT levels were the independent risk factor on the occurrence of CALs; the adjusted odds ratio (OR) was 1.523 (95 % CI: 1.144, 2.028). Similar results were found in stratification analysis and sensitivity analysis.
KD patients with high APTT levels (≥46 s) before IVIG treatment may be more prone to developing CALs in the acute phase of KD.
川崎病（KD）是一种影响中等大小动脉的急性全身性炎症。冠状动脉病变（CALs）是KD最严重的并发症或后遗症。强烈的炎症反应导致血小板活化，进一步加剧炎症，这在KD患者CALs的发病机制中起重要作用。此外，凝血因子与血小板活化密切相关。因此，我们推测活化部分凝血活酶时间（APTT），一种凝血因子功能指标，可能参与CALs的发生，但尚未进行过探索。本研究旨在探讨APTT水平对KD急性期CALs发生的影响。
在温州医科大学附属育英儿童医院招募了10年间共2303例KD患者。共有1715例完成随访的患者纳入最终分析，并在接受静脉注射免疫球蛋白（IVIG）治疗前以46秒为界分为低APTT组和高APTT组。采用多因素logistic回归分析和分层分析分别评估APTT水平对CALs发生的独立影响以及APTT水平对不同亚组CALs发生的影响。
低APTT组和高APTT组CALs的发生率分别为12.5%和17.5%（P = 0.005）。APTT水平高的患者CRP水平更高（P < 0.001）。高APTT水平是CALs发生的独立危险因素；调整后的比值比（OR）为1.523（95%CI：1.144，2.028）。在分层分析和敏感性分析中发现了类似结果。
IVIG治疗前APTT水平高（≥46秒）的KD患者在KD急性期可能更容易发生CALs。
