CORONARY ARTERY ABNORMALITIES

冠状动脉异常

基本信息

批准号：
7725335
负责人：
ANDRAS BRATINCSAK
金额：
$ 1.78万
依托单位：
UNIVERSITY OF HAWAII AT MANOA
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-01 至 2009-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7725335
关键词：
6 year old Academy American American Heart Association Anterior Arteries Blood Circulation Body Surface Area Caliber Child Clinical Computer Retrieval of Information on Scientific Projects Database Coronary Circulation Coronary artery Detection Diagnosis Diagnostic Dilatation - action Echocardiography Enlargement of lymph nodes Etiology Fever Funding Gold Grant Guidelines Hawaii Health High Cardiac Output Incidence Inflammatory Institution Intravenous Immunoglobulins Japanese Population Lead Lesion Life Lymphatic Diseases Measurement Measures Metabolic Methods Morbidity - disease rate Mucocutaneous Lymph Node Syndrome Myocardial Ischemia Normal Range Pathological Dilatation Patients Pediatrics Process Rate Reporting Research Research Personnel Resources Right coronary artery structure Score Source Standards of Weights and Measures Time United States United States National Institutes of Health Vasculitis Vasodilation Week age related base left coronary artery mortality prevent response two-dimensional

项目摘要

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Kawasaki disease (KD), a general vasculitis illness characterized by fever, mucocutaneous lesions and lymphadenopathy, is three times more prevalent in Hawaii than in the continental United States: 45 cases/100,000 children/year in Hawaii. Despite its high incidence, the etiology of KD is still unknown. Two weeks after diagnosis of KD, coronary artery abnormalities (CAA) can be demonstrated in up to 25% of the cases. The introduction of IVIG therapy had reduced the incidence of CAA to 8%. CAA may lead to myocardial ischemia later in life increasing the morbidity and mortality of KD. Therefore, diagnosing and adequately treating KD is crucial to preventing CAA and its long-term complications. The diagnosis of KD is based on clinical features, but in clinically incomplete presentations, CAA itself may be part of the diagnostic criteria according to the guidelines of the American Heart Association and the American Academy of Pediatrics. The gold standard method of detecting CAA is 2-dimensional echocardiography measuring the diameter of three coronary arteries: left main coronary artery (LMCA), left anterior descending artery (LAD) and right coronary artery (RCA). Normal values of coronary arteries in children and the detection of abnormalities were previously based on criteria constituted by the Japanese Ministry of Health. Instead of these age dependent values, de Zorzi et al introduced normal values and Z-scores (standard deviation from normal) based on the body surface area of children. Their study reported a much higher incidence of CAA associated with KD, especially in the early, febrile period of the illness. Fever, a general response to infectious and inflammatory processes, results in redistribution of blood circulation and vasodilation of specific vessels. Increased metabolic rate in fever demands higher cardiac output that requires increased coronary circulation. Thus, it can be hypothesized that fever itself may result in dilatation of the coronary arteries. What causes the specific vasculitis of the coronary arteries in a febrile illness like KD is yet to be determined. In this study we aim to compare the diameter of three coronary arteries in febrile and non-febrile children. The coronary artery measurements of hospitalized patients (6 months to 6 years old children) in a febrile period of their illness will be compared to coronary artery measurements of healthy non-febrile children, who previously underwent echocardiography. CAA will be determined according to de Zorzi's criteria. We will also determine the diameter of the coronary arteries of patients with Kawasaki disease in Hawaii and compare it to de Zorzi's standardized Z-score measurements. If the hypothesis, that fever itself may result in transient coronary artery dilatation, proves to be valid, the diagnostic criteria of incomplete KD may need to be revised.

该子项目是利用该技术的众多研究子项目之一资源由 NIH/NCRR 资助的中心拨款提供。子项目及研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金，因此可以在其他 CRISP 条目中表示。列出的机构是对于中心来说，它不一定是研究者的机构。川崎病 (KD) 是一种以发烧、皮肤粘膜病变和淋巴结病为特征的一般性血管炎疾病，夏威夷的发病率是美国大陆的三倍：夏威夷每年每 100,000 名儿童 45 例。尽管发病率很高，但 KD 的病因仍不清楚。诊断 KD 两周后，高达 25% 的病例可出现冠状动脉异常 (CAA)。 IVIG 疗法的引入已将 CAA 的发生率降低至 8%。 CAA 可能导致晚年心肌缺血，增加 KD 的发病率和死亡率。因此，诊断和充分治疗 KD 对于预防 CAA 及其长期并发症至关重要。 KD 的诊断基于临床特征，但在临床表现不完整的情况下，根据美国心脏协会和美国儿科学会的指南，CAA 本身可能是诊断标准的一部分。检测 CAA 的金标准方法是二维超声心动图测量三个冠状动脉的直径：左冠状动脉主干 (LMCA)、左前降支动脉 (LAD) 和右冠状动脉 (RCA)。儿童冠状动脉的正常值和异常检测以前是基于日本厚生省制定的标准。 de Zorzi 等人引入了基于儿童体表面积的正常值和 Z 分数（正常值的标准差），而不是这些与年龄相关的值。他们的研究报告称，与川崎病相关的 CAA 发病率要高得多，尤其是在疾病的早期发热期。发烧是对感染和炎症过程的一般反应，会导致血液循环重新分布和特定血管的血管舒张。发烧时代谢率增加需要更高的心输出量，这需要增加冠状循环。因此，可以假设发烧本身可能导致冠状动脉扩张。在像川崎病这样的发热性疾病中，导致特定冠状动脉血管炎的原因尚未确定。在这项研究中，我们的目的是比较发热和非发热儿童的三个冠状动脉的直径。住院患者（6 个月至 6 岁儿童）在发烧期间的冠状动脉测量结果将与之前接受过超声心动图检查的健康非发烧儿童的冠状动脉测量结果进行比较。 CAA将根据de Zorzi的标准确定。我们还将确定夏威夷川崎病患者的冠状动脉直径，并将其与 de Zorzi 的标准化 Z 分数测量结果进行比较。如果发热本身可能导致短暂冠状动脉扩张的假设被证明是有效的，那么不完全川崎病的诊断标准可能需要修改。