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目的 探讨年龄和身体质量指数（BMI）对川崎病患儿血管内皮功能及冠状动脉损伤（CAL）的影响机制。方法 回顾性选取华中科技大学同济医学院附属武汉儿童医院2024年4月至2025年1月收治的200例川崎病患儿临床资料，按照年龄将患儿分为婴儿组（﹤1岁，84例）、幼儿组（1～3岁，57例）、学龄前组（4～6岁，59例）；依据同龄同性别儿童BMI第85百分位、第95百分位标准将患儿分为正常组（119例）、超重组（42例）、肥胖组（39例）；根据是否发生CAL分为CAL组（86例）与非CAL组（114例）。比较不同年龄、BMI的川崎病患儿血管内皮功能指标，比较CAL组与非CAL组患儿临床资料，多因素Logistic回归分析川崎病患儿发生CAL的影响因素。结果 婴儿组颈动脉内膜中层厚度（IMT）、颈动脉僵硬度指数（SI）高于幼儿组及学龄前组（P<0.05），反应性充血指数（RHI）、血流介导的内皮依赖性血管舒张功能（FMD）、硝酸甘油介导的非内皮依赖性血管舒张功能（NMD）显著低于幼儿组及学龄前组（P<0.05）；幼儿组IMT显著高于学龄前组（P<0.05）。肥胖组IMT、SI显著高于超重组及正常组（P<0.05）,RHI、FMD、NMD显著低于正常组（P<0.05），超重组IMT显著高于正常组（P<0.05）,RHI、FMD、NMD显著低于正常组（P<0.05）。CAL组年龄≤3岁患儿比例、超重/肥胖患儿比例、C反应蛋白（CRP）、肿瘤坏死因子α(TNF-α)、IMT、SI水平显著高于非CAL组（P<0.05）,CAL组RHI、FMD、NMD水平显著低于非CAL组（P<0.05）。多因素Logistic回归分析显示，年龄、BMI、CRP、TNF-α、IMT、SI、RHI、FMD、NMD是川崎病患儿发生CAL的独立影响因素（P<0.05）。结论 不同年龄、BMI川崎病患儿血管内皮功能存在差异，且年龄、BMI、CRP、TNF-α、IMT、SI、RHI、FMD、NMD是川崎病患儿发生CAL的独立影响因素。
Abstract：Objective To investigate the mechanism of influence of age and body mass index(BMI) on vascular endothelial function and coronary artery lesion(CAL) in children with Kawasaki disease(KD). Methods The clinical data of 200 children with KD admitted to Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from April 2024 to January 2025 were retrospectively collected. The patients were divided into an infant group(<1 year, n=84), a toddler group(1–3 years, n=57), and a preschool group(4–6 years, n=59) according to age. Based on the 85 th and 95 th percentile of BMI for children of the same age and sex, they were classified into a normal group(n=119), an overweight group(n=42), and an obesity group(n=39). According to the presence of CAL, they were divided into a CAL group(n=86) and a non-CAL group(n=114). Vascular endothelial function indices were compared among children with KD of different ages and BMI categories. Clinical data were compared between the CAL group and the non-CAL group. Multivariate logistic regression analysis was used to identify influencing factors for CAL in children with KD. Results The carotid intima-media thickness(IMT) and carotid stiffness index(SI) in the infant group were higher than those in the young children group and the preschool group(P<0.05), while the reactive hyperemia index(RHI), flow-mediated dilation(FMD), and nitroglycerin-mediated dilation(NMD) were significantly lower than those in the young children group and the preschool group(P<0.05). The IMT in the young children group was significantly higher than that in the preschool group(P<0.05). IMT and SI in the obese group were significantly higher than those in the overweight group and the normal group(P<0.05), while RHI, FMD, and NMD were significantly lower than those in the normal group(P<0.05). IMT in the overweight group was significantly higher than that in the normal group(P<0.05), while RHI, FMD, and NMD were significantly lower than those in the normal group(P<0.05). The proportion of children aged≤3 years, the proportion of overweight/obese children, and the levels of C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), IMT, and SI in the CAL group were significantly higher than those in the n-CAL group(P<0.05), while the levels of RHI, FMD, and NMD in the CAL group were significantly lower than those in the n-CAL group(P<0.05). Multivariate Logistic regression analysis showed that age, BMI, CRP, TNF-α, IMT, SI, RHI, FMD, and NMD were independent influencing factors for CAL in children with KD(P<0.05). Conclusion Vascular endothelial function differs in children with KD of different ages and BMI, and age, BMI, CRP, TNF-α, IMT, SI, RHI, FMD, and NMD are independent influencing factors for CAL occurrence in children with KD.
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基本信息:
中图分类号:R725.4
引用信息:
[1]夏琨,张勇,周丹,等.年龄和身体质量指数对川崎病患儿血管内皮功能及冠状动脉损伤的影响机制研究[J].转化医学杂志,2025,14(12):16-20.
基金信息:
湖北省卫生健康委员会科研项目(WJ2021M019)
2025-12-20
2025-12-20