Ultrasound evaluation of endothelial dysfunction in immunoglobulin-resistant children with acute Kawasaki disease.

Autor: Wen Y; Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China. wenyz21@hotmail.com., Yang Y; Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China. yangyfcd@163.com., Wen Y; Ultrasonography Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China., Xi J; Ultrasonography Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China., Chen T; Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China., Lu Y; Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China., Wang L; Department of Clinical Laboratory, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China., Liu Y; Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China., Si F; Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
Jazyk: angličtina
Zdroj: Clinical rheumatology [Clin Rheumatol] 2022 Dec; Vol. 41 (12), pp. 3797-3805. Date of Electronic Publication: 2022 Aug 18.
DOI: 10.1007/s10067-022-06341-6
Abstrakt: Introduction: Given the evidence that brachial artery flow-mediated dilation (FMD) is declined in children later after the onset of Kawasaki disease (KD), we hypothesized that indicators that detect the situation of the endothelium are useful parameters that can accurately reflect subclinical dysfunction in resistant patients and assist in differentiating patients with KD at a higher risk of IVIG resistance, which may be valuable in better understanding how to protect patients from endothelial and thrombotic complications.
Methods: Fifty IVIG-resistant KD children, 120 IVIG-responsive KD children, 35 febrile children with acute upper respiratory infection, and 50 healthy controls were recruited, and indicators reflecting endothelial inflammation, including flow-mediated dilation (FMD), were measured. Receiver operating characteristic (ROC) curve analysis was utilized to determine the threshold values of these indicators of IVIG resistance. Multiple logistic regression analysis was performed to determine whether FMD was an independent predictor of IVIG-resistant patients.
Results: In comparison with the lab data, PCT, Na + , and FMD exhibited AUCs of 0.727, 0.653, and 0.698 (P < 0.05), respectively, in predicting IVIG resistance in KD through ROC analysis. PCT > 1.69 ng/ml, Na +  < 133.2 mmol/l, and FMD < 5.79% were independent predictors of IVIG resistance in KD (OR 4.257, 3.516, 3.563, 95% CI 1.549 ~ 11.700, 1.277 ~ 9.680, 1.299 ~ 9.772, P < 0.05).
Conclusion: More severe endothelial dysfunction, especially lower FMD, was present in IVIG-resistant patients than in IVIG-responsive patients. It is a helpful diagnostic tool that provides supportive criteria to detect KD patients at a higher risk of IVIG resistance when FMD < 5.79% in children. Key Points • IVIG-resistant KD patients have more severe endothelial dysfunction than IVIG-sensitive patients. • FMD < 5.79% may indicate an increased risk of IVIG resistance in children with Kawasaki disease.
(© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)
Databáze: MEDLINE
Externí odkaz: