摘要
为探讨川崎病后肱动脉内皮依赖性血管舒张,明确川崎病急性期丙种球蛋白的应用是否对远期内皮功能异常有作用,以及维生素C的快速输注是否能改善外周血管内皮功能。应用高分辨力超声评价39例有川崎病病史患者(KD组)及17例健康对照者的肱动脉内皮功能;对KD组行静脉内输注维生素C(VC组)或安慰剂(NS组),在输注后重新评价肱动脉的内皮功能。结果显示,反应性充血所致的肱动脉内径百分变化率(RH％)在KD组明显低于对照组(P<0.0001);在接受和未行丙种球蛋白治疗者RH％无显著性差异(P=0.33);VC组输注后RH％明显增加(P<0.0001),NS组输注后RH％无明显增加(P=0.20),RH％在KD组较健康儿童减低。提示川崎病后存在周围血管内皮功能的异常;川崎病急性期大剂量丙种球蛋白的早期治疗并未能干预远期周围血管内皮功能,而快速静脉内输注维生素C可使川崎病后受损的血管内皮功能得以恢复。
High-resolution ultrasonography has been used to analyze brachial artery responses to reactive hyperemia(with increased flow causing endothelial-dependent dilation) after KD.To determine whether the use of gamma immunoglobulin therapy in acute stage of KD affects the later endothelial dysfunction, and to investigate whether the acute administration of vitamin C can improve the peripheral blood vessel endothelial dysfunction, the endothelia-dependent vasodilation of the brachial artery was evaluated in 39 pa-tients(age = 7.1 ± 2.7 years)at 1 - 10 years after acute KD(KD group)and 17 matched healthy subjects(7.0± 3.1 years) .With the high-resolution ultrasonography, the brachial vasodilations were reassessed before and after vitamin C or placebo infusion intravenously in KD group. The results showed that the change rate (RH%) in diameter of the brachial artery induced by reactive hyperemia in KD group (6.2% ± 3.9%) was significantly less than that in the control group(14.6% ± 6. 8% , P<0.0001). There was no significant difference in RH% between the patients who received gamma immunoglobulin(6.0% ±4.0%) and those who did not (7.9% ± 3.3%, P = 0.33) . Intravenous infusion of vitamin C significantly increased RH% in 19 patients with the history of KD(6.6% ± 3. 5% to 13.0% ± 5. 5%, P<0.0001) .After placebo administration in 20 patients with the history of KD, there was no significant increase in RH% (P = 0.20) . The decreased RH% in KD group compared with the healthy children indicates that the endothelial dysfunction of the peripheral blood vessel exists after KD. Although it is not influenced by early treatment with high-dose gamma immunoglobulin in the acute stage of KD, but the peripheral vascular endothelial function can be restored with emergent-intravenous administration of vitamin C.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2003年第11期688-691,共4页
Journal of Clinical Pediatrics
基金
国家自然科学基金(项目编号:30270560)
