| Background and objective Kawasaki disease (KD) is an acute, systemic febrile vasculitis of unknown origin that affects primarily infants and young children. The incidence is increasing every year since the first case was described by Dr. Kawasaki in Japan in 1967. The most important complication of KD is coronary artery lesion including dilation thrombosis and atherosclerosis ,which leads to aneurysm formation in 20-30% of patients. Some patients died of congestive heart failure ,myocardial infarction cardiac arrhythmia. KD become a main cause of acquired heart disease instead of rheumatic fever and may be endangerous factor of Atherosclerosis in adults. Therefore ,Predicting and preventing conorary artery lesion at early stage is valuable ,Which was paid attention by the pediatric cardiac field. Some research suggest that the process of KD is related to endothelial dysfunction and the situation of blood extreme coagulatlon. fibrinolysis system is one of main agent of thrombosis and promoting blood coagulation. Fibrinolytic function is depended on tissue plasminogen activator and inhibitor-1 mainly. The aim of the present study was to explore the change of fibrinolytic function in development of KD and relationship of coronary artery lesion ,Which can not only predict coronary complication but also may provide evidence a viable therapeutic target for the prevention of KD-related CALS. Method The study included 35 Kawasaki disease children(21 boys and 14 girls )who were treated in children,s hospital in Shanxi province from January 2003 to June 2004The range of age is from 9 month to 8 years old. Average age is 2.4±0.4 years old. All KD patients including 12 presenting with coronary lesions,or 23 without were enrolled fulfilled the revised 1984 KD criteria of the Kawasaki Disease Research Committee of Japan and 20 healthy controls were age-matched healthy children attended healthy examination in the same hospital. Plasma levels of t-PA ,PAI-1 antigen were measured by enzyme-linked immunosorbent assay and CRP ,platet count were investigated using full-automatic immunologic turbidimetric quantitative analysis and full-automatic hemocytometer respectively among 35 KD patients and 20 healthy children . Correlation analysis was done between t-PA ,PAI-1 and CRP ,platet count. Patients with KD were separated into acute phase group,recovery phase group and 12 patients with coronary artery lesion group,23 non-coronary artery lesion group . Results The level of plasma PAI-1 in the acute phase group (29.55±5.31)ng/ml and recovery phase group (40.82±6.42)ng/ml were significantly higher than those in the healthy group(21.05±7.64)ng/ml,(p﹤0.01). Plasma t-PA in the acute phase group(14.44±3.48) ng/ml and recovery phase group (18.42±4.49)ng/ml were significantly higher than those in the healthy group (9.79±3.87)ng/ml,(P﹤0.01). The level of plasma PAI-1 in CAL group in the acute phase(32.32±4.79)ng/ml was significantly higher than group NCAL(28.86±4.08)ng/ml ,(P﹤0.05) , The level of plasma PAI-1 in recovery phase in group CAL(45.24±5.24)ng/ml was significantly higher than group NCAL(38.52±5.82)ng/ml ,(P﹤0.01) .The Level of t-PA in group CAL (22.61±4.39)ng/ml was significantly higher than group NCAL especially in recovery phase(16.68±4.74)ng/ml .( P﹤0.01) . The ratio of t-PA to PAI-1 in patients with CAL is lower than not CAL in the acute phase and recovery phase(P﹤0.01,P﹤0.05). PAI-1 ,t-PA in group CAL has positive correlation with CRP (r=0.760,P <0.01;r=0.7,P <0.01). But not with PLT count. Conclusion Impairment of the fibrinolytic system is related to endothelial dysfunction in KD. The circulating levels of t-PA, PAI-1 and the ratio of t-PA to PAI-1 are related to the severity of vascular damage and that high t-PA,PAI-1 levels and low t-PA/ PAI-1 are susceptible to coronaryartery complication in KD .They may be a sensitive predictor of coronary artery lesion and that they can serve as a therapeutic target for prevention of KD with CALs. |
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