川崎病患儿凝血功能、D-二聚体水平与冠状动脉病变的关系

Relationship Among Coagulation Function, D-dimer Level and Coronary Artery Lesions in Children with Kawasaki Disease

【目的】探讨川崎病患儿急性期凝血功能、D-二聚体的水平与冠状动脉病变（CAL）的关系。【方法】在本院儿科住院治疗的川崎痛患儿194例作为观察组，根据观察组的心脏超声心动图检查结果，分为42例cAL组和152例CAL（NcAL组），并同时设置健康对照组60例。检测所有研究对象的凝血功能，包含凝血酶时间（TT），部分凝血酶原活化时间（APTT），纤维蛋白原定量（FIB）值，以及D-二聚体（D-dimer）水平，对结果进行统计学分析。【结果】川崎病CAL组及NCAL组的APTT、TT均比对照组缩短，而FIB、D-dimer均高于对照组，且差异有显著性（P〈0．05）。其中CAL组与NCAL组的TT及D-dimer水平相比较差异有显著性（P〈0．05），Logistic回归分析提示TT是CAL的独立影响因素（Pd0．05），川崎病惠儿TT每增加1S，其发生CAL的风险增加0．838倍。TT诊断CAL的ROC曲线面积为0．608。【结论】川崎病患儿急性期处于高凝状态，TT是影响CAL较为敏感的独立因素，同时可推测CAL与血管炎症活动有关。

[Objective]To investigate the relationship among coagulation function, D-dimer level and coro- nary artery lesions in children with Kawasaki Disease.[Methods]A total of 194 cases with Kawasaki disease children who were diagnosed in the department of pediatrics in our hospital were collected in the study. Ac cording to the results of heart eehocardiography for coronary artery lesions, patients were divided into the cor- onary artery lesions group （CAL, n = 42） and the no-coronary artery lesions group （NCAL, n = 152）. At the same time 60 healthy volunteers were formed the control group.. Blood coagulation function was tested in all subjects, including thrombin time （TT）, partial prothrombin activation time （APTT）, fibrinogen （FIB） quantitative values, and D - dimer level. The laboratory results were statistically analyzed. [Results] APTT and TT in both CAL and NCAL groups of Kawasaki disease were shorter than in the control group, while FIB and D- dimer were higher than the control group. The difference was statistically significant （P % 0.05）. There was a significant difference in the TT and D-dimer levels between the CAL group and the NCAL group （ P %0.05）. Logistic regression analysis indicated that TT was an independent influencing factor of coronary artery lesions （ P %0.05）. For every one second increase in TT of Kawasaki disease, the risk of coronary ar- tery lesions increased by 0.838 -fold . The ROC curve area （AUCROC） for TT to diagnose coronary artery le- sions of was 0.608. [Conclusion] Children with Kawasaki disease are hypercoagulable in the acute stage. Coag- ulation function TT is an independent and sensitive factor to indicate CAL. At the same time, it can also be speculated that coronary artery lesions is associated with vascular inflammation activity.