| Part1 Retrospective Analysis of 149 Cases of Kawasaki DiseaseObjective: To explore the differences of clinical characteristics between typical KD and incomplete KD to offer help for clinical diagnosis.To explore the risk factors of the intravenous injection gamma globulin(IVIG) non-sensitive KD and KD with coronary artery lesion to provide the reference for clinical treatment and diagnosis.Methods: Analyzed retrospectively the medical records of 149 cases of hospitalized children with Kawasaki disease in affiliated hospital of North sichuan medical college. All of the cases were divided into KD with Coronary artery lesions and without Coronary artery lesions groups base on ultrasound examination results,typical and atypical KD groups base on number of clinical symptoms. According to the curative effect of intravenous injection gamma globulin,divided 149 cases into IVIG sensitive and non-sensitive groups. statistically comparative analysis was performed for the general characteristics and the main clinical manifestations and uxiliary examination of different groups.Results:1. Out of 149 cases of KD patients, 98 cases were boys and 51 cases were girls,the ratio of them was 1.92. The ages of the KD patients varied from 2 months to 11 years.The median of age was 2 years and 3 months old and the highest incidence(53.69%)of KD was in young children(1~3 year old). KD occurred all the year and the highest incidence(29.53%)of KD was in the spring(from March to May).2. Out of 149 cases of KD patients,112 cases were typical KD(75.17%) and 37(24.83%)cases were incomplete KD(IKD). The ratio of male to female in typical KD cases was 1.80,while the ratio in incomplete KD cases was 2.36. The ages of the typical KD varied from 5 months to 5 years,the median of age was 3 years,while ages of the incomplete KD varied from 2 months to 11 years. The median of age was 2 years. the gender,age,Seasonal distribution,there are no significant differences between typical KD cases and incomplete KD(p>0.05). The time from the beginning of the KD to definite diagnosis that the doctor gave,there was significant difference(z=2.508,p=0.012),the time of incomplete KD was longer. Patients with typical KD were more likely to have clinical features including chapped lips,congestion of the bulbar conjunctiva,red bayberry tongue, rash, fingers(toes) end membrane peeling,and foot/hart swelling,perianal skin membrane peeling. But the incidence of the cervical lymph node enlargement, there are no significant differences. Analysis showed that there was a higher incidence of WBC>15×109/L,and The lower incidence of PCT increased for incomplete KD. Abnormal electrocardiogram, Pericardial effusion,Pneumonia, there were no significant differences between typical KD cases and incomplete KD(p>0.05). In addition, the ultrasonic cardiogram showed that there was higher incidence of CAL for incomplete KD group.3. A total of 149 cases were divided into CAL group and NCAL group,the cases of CAL group were 44(29.53%)and NCAL group were 105(70.47%).The ratio of male to female that CAL group was 2.38, while the ratio of cases without CAL was 1.76. The ages of the CAL group varied from 4 months to 11 years. The median of age was 2 years,while ages of the NCAL group varied from 2 months to 7 years. The median of age was 35 months old. the gender and age and Seasonal distribution and fever duration,there were no significant differences between two groups(p>0.05). But there was higher incidence of Fever time>10d for CAL group,and the fever duration before treatment with IVIG is longer on CAL group. NCAL group were more likely to have symptoms of foot/hard swelling. The incidence of the rest of clinical features, there were no significant differences between CAL group and NCAL group. Single factor analysis Combined with logistic regression analysis showed that PLT increased,FIB increased,Abnormal Electrocardiogram,pericardial effusion were the independent risk factors of KD with CAL.4. According to the curative effect of IVIG,a total of 149 cases were divided into IVIG sensitive group(14 cases,9.40%)and non-sensitive groups(135cases,90.60%). there were no significant differences for the gender and age and Seasonal distribution between two groups(p>0.05). The time from the onset of disease to starting treatment with IVIG was longer for IVIG sensitive group than non-sensitive groups. The gender, age, Seasonal distribution and fever duration,there were no significant differences between two groups(p>0.05). Non-sensitive group was more likely to have symptoms of foot/hard swelling. There were no significant differences for the incidence of the rest of clinical features and CAL between two groups. Single factor analysis Combined with logistic regression analysis showed that ALB reduced and less time from the onset of disease to starting treatment with IVIG were the independent risk factors of IVIG non-sensitive KD.Conclusion: KD was the most common in young children patients(from 1 to 3 years old),it occurred all the year and the highest incidence of KD was in the spring(from March to May),and the incidence of KD was higher in men.The incidence of almost all of the KD,s clinical features were lower in incomplete KD than typical KD,and patient with incomplete KD was more likely to be misdiagnosed and lead to coronary artery lesion.Almost all the laboratory examination indexes for KD can be applied to the IKD,especially WBC>15×109/L. PLT increased,FIB increased,Abnormal Electrocardiogram, Pericardial effusion were the independent risk factors of KD with CAL. ALB reduced and less time from the onset of disease to starting treatment with IVIG were the independent risk factors of IVIG non-sensitive KD.Part 2 The Exploration of AngⅡ,8-ISO-PGF2 a,Ox-LDL in Patientswith Kawasaki DiseaseObjective: To understanding the plasma concentrations of AngⅡ,8-ISO-PGF2 a,ox-LDL in KD,s acute phase and to explore the oxidative stress state in the acute phase of kawasaki disease and the correlation between oxidative stress state and Ang II-NADPH oxidase-ROS pathways. Explore the the effect of IVIG on oxidative stress state of kawasaki disease.Methods: 30 hospitalized children with typical kawasaki disease in our hospital and 20 healthy children were enrolled into the study. AngⅡ,8-ISO-PGF2 a, Ox-LDL level were measured by enzyme-linked immunosorbent assay(ELISA).Statistical analysis of data used Excel and Spss13.0.Results:1. In the acute phase of Kawasaki disease,the plasma concentrations of AngⅡ, 8-ISO-PGF2 a, Ox-LDL in patients were higher than normal children,and there were significant differences(p<0.05).2. There was a positive correlation between Ang and Ⅱ 8-ISO-PGF2α in the acute phase of Kawasaki disease.( r=0.482, p=0.007). The plasma concentrations of Ang Ⅱ has a no correlation with Ox-LDL.3. The plasma concentrations of AngⅡand 8-ISO-PGF2 a was lower after treatment with IVIG than before IVIG treatment,and there was no significant difference between normal children and the patient have was treated with IVIG,but 8-ISO-PGF2 a was still higher than the normal children. The plasma concentrations of Ox-LDL in patient had no significant difference between post-treatment and pre-treatment.Conclusion: The acute phase of Kawasaki disease was in an oxidative stress state,and Ang II-NADPH oxidase-ROS pathways played an important role in the oxidative stress state in the acute phase of Kawasaki disease. The oxidative stress and Ox-LDL may be involved in the vasculitis of Kawasaki disease. IVIG treatment could affects oxidative stress by the inhibition of Ang II-NADPH oxidase-ROS pathways. |
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