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目的探讨川崎病(Kawasaki disease,KD)患儿血脂代谢与冠状动脉病变之间的关系。方法纳入2007年1月2009年10月住院治疗的82例KD患儿,检测治疗前后血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、极低密度脂蛋白(VLDL-C)、载脂蛋白A1(ApoA1)及载脂蛋白B100(ApoB100)水平。选取50例健康儿童作为对照。KD患儿在治疗前行超声心动图检查,根据超声心动图显示将KD组再分为冠状动脉病变组(CAL组,n=31)和非冠状动脉病变组(NCAL,n=51)。结果治疗前,KD患儿TC、ApoA1、HDL-C降低,TG、LDL-C升高,与正常儿童相比有统计学意义(P<0.05)。KD患儿CAL组较NCAL组变化更明显,有统计学意义(P<0.05)。VLDL-C和ApoB100水平KD患儿与正常儿童比较、NCAL组与CAL组比较变化均不明显(P>0.05)。治疗后与治疗前相比,NCAL组TC、TG、HDL-C、LDL-C、ApoA1恢复正常(P<0.05)),而CAL组仅TC、LDL-C、ApoA1恢复正常(P<0.05)。结论 KD患儿存在血脂代谢紊乱,TC、TG、HDL-C、LDL-C、ApoA1与冠状动脉的损害有关,应早期进行干预。
Objective To investigate the relationship between lipid metabolism and coronary artery disease in children with Kawasaki disease (KD). Methods Eighty-two KD children hospitalized in our hospital from January 2007 to October 2009 were enrolled in this study. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), very low density lipoprotein (VLDL-C), apolipoprotein A1 (ApoA1) and apolipoprotein B100 (ApoB100). Fifty healthy children were selected as control. KD children underwent echocardiography before treatment, and KD groups were further divided into coronary artery disease group (CAL group, n = 31) and non-coronary artery disease group (NCAL, n = 51) according to echocardiography. Results Before treatment, the levels of TC, ApoA1, HDL-C, TG and LDL-C in children with KD were significantly higher than those in normal children (P <0.05). The changes of CAL group in KD patients were more obvious than NCAL group (P <0.05). VLDL-C and ApoB100 levels in children with KD compared with normal children, NCAL group and CAL were no significant changes (P> 0.05). The levels of TC, TG, HDL-C, LDL-C and ApoA1 in NCAL group returned to normal after treatment (P <0.05), while TC, LDL-C and ApoA1 in CAL group returned to normal . Conclusions There are disorders of blood lipid metabolism in children with KD. The levels of TC, TG, HDL-C, LDL-C and ApoA1 are related to the damage of coronary artery. Intervention should be done early.