40例川崎病患儿血脂与冠状动脉损害的关系研究

Clinical research on relation between blood lipids and coronary artery change in 40 children patients with Kawasaki disease

目的研究川崎病患儿血脂代谢变化与冠状动脉(简称冠脉)损害的关系,探讨是否可以将血脂作为川崎病后监测指标,尤其对冠脉病变组通过早期血脂干预达到促进冠脉修复的目的。方法选择40例符合川崎病诊断标准的患儿,在急性期行心脏彩超检查,分为冠脉病变组和冠脉正常组各20例,同时进行血脂6项检测:三酰甘油(TG)、总胆固醇(CHOL)、载脂蛋白A-1(ApoA1)、载脂蛋白B(ApoB)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)。并于恢复期的1、3、6、12个月进行血脂和心脏彩超检查,两组冠脉和血脂之间进行比较。结果川崎病患儿无论有无冠脉损害在急性期和恢复期均存在血脂代谢紊乱,但是与冠脉正常比较,冠脉病变组TG在急性期和恢复期水平明显升高,差异有统计学意义(P<0.01);CHOL的升高水平、HDL-C的下降水平两组比较差异有统计学意义(P<0.05);ApoA1、ApoB、LDL-C的异常在两组比较差异无统计学意义(P>0.05)。两组趋势比较血脂代谢紊乱恢复正常水平冠脉正常组优于病变组。结论川崎病患儿有冠脉损害时血脂紊乱更为严重,因此对病变组尤其应注意血脂监测,可以考虑通过指导饮食、改变生活习惯、临床早期干预来达到促进冠脉修复的目的。

Objective To investigate the relation between the blood lipid metabolic change and the pathological change of coronary artery in children patients with Kawasaki disease,and to discuss whether the blood lipid should be the monitor index on the convalescent stage of Kawasaki disease,especially achieve the aim to cure the pathological coronary artery by intervening the blood lipid early in the pathological coronary artery group.Methods Forty cases according to the Kawasaki disease diagnosis standard were divided into two groups： pathological coronary artery group（20 cases） and normal coronary artery group（20 cases） were given echocardiogram and 6 tests of blood lipid including triglyceride（TG）,cholesterol（CHOL）,apolipoprotein A-1（ApoA1）,apolipoprotein B（ApoB）,low density lipoprotein cholesterol（LDL-C） and high density lipoprotein cholesterol（HDL-C） in the acute stage,and subsequently echocardiogram and 6 tests of blood lipid in 1-month,3-month,6-month,12-month on the convalescent stage;comparisons of results of echocardiogram and 6 tests of blood lipid were made.Results Metabolic disorders existed in both of the acute and convalescent stages of Kawasaki disease.By comparing two groups,there was significance difference of higher TG in the pathological coronary artery group of this disease（P0.01）;the statistical significance existed in CHOL increase,HDL-C descent（P0.05）;no statistical significance could be found in the abnormality of ApoA1,ApoB and LDL-C（P0.05）.The tendency of two groups manifested that the control group was superior to the pathological coronary artery group in the recovering of abnormality of blood lipid metabolism.Conclusion The children patients with Kawasaki disease will have more severe abnormality of the blood lipid metabolism when complicating with impairment of coronary artery.So we must monitor the blood-fat changing.At the same time,it should be considered to promote the recover of coronary artery by food and drink guidance,changing living habit and clincal early intervention.