川崎病致肾动脉损害的探讨

Renal artery injury caused by Kawasaki disease

目的探讨川崎病(KD)对肾动脉造成的损害。方法 43例KD患儿纳入研究,根据其急性期血压分为血压正常和血压升高两个亚组;18例急性上呼吸道感染发热患儿作为对照(简称上感组)。比较组间肾动脉主干起始部内径、肾主动脉和叶间动脉血流动力学参数及肾素活性、血管紧张素Ⅱ和醛固酮水平。结果急性期KD两个亚组肾动脉主干起始部内径小于上感组,肾主动脉阻力指数(RI)大于上感组,舒张末期最低流速(EDV)小于上感组(P<0.05);血压升高亚组肾叶间动脉EDV小于血压正常亚组,RI大于血压正常亚组和上感组,其肾素活性、血管紧张素Ⅱ及醛固酮水平均较血压正常亚组高(P<0.05)。亚急性期血压升高亚组肾叶间动脉EDV高于急性期,RI值低于急性期(P<0.05)。结论 KD可导致肾动脉损伤及早期血流动力学改变,并使部分病例出现暂时性血压升高现象。

Objective To investigate renal artery injury caused by Kawasaki disease（KD）. Methods Forty-three children with KD were enrolled in the study. According to the blood pressure in the acute stage, these children were classified into normal blood pressure subgroup and increased blood pressure subgroup. Eighteen children with fever caused by acute upper respiratory tract infection were enrolled as the control group. The diameter of the origin of the main renal artery, hemodynamic parameters of the main renal artery and the renal interlobar artery, rennin activity, and levels of angiotensin II and aldosterone were compared between groups. Results During the acute stage of KD, both subgroups had a significantly smaller diameter of the origin of the main renal artery, a significantly higher resistance index（RI） of the main renal artery, and a significantly lower end-diastolic velocity（EDV） than the control group（P0.05）.The increased blood pressure subgroup had a significantly lower EDV of the interlobar artery than the normal blood pressure subgroup, a significantly higher RI than the normal blood pressure subgroup and the control group, as well as a significantly higher rennin activity and significantly higher levels of angiotensin Ⅱ and aldosterone than the normal blood pressure subgroup（P0.05）. A significantly increased EDV and a significantly reduced RI of the renal interlobar artery were observed in the increased blood pressure subgroup in the subacute stage compared with the acute stage（P0.05）. Conclusions KD may cause renal artery injury and early hemodynamic changes, resulting in a transient increase in blood pressure in some patients.