The Clinical Evaluation Of Serum Osteoprotegerin And Dual-source Computed Tomography In Diagnosis Of Coronary Artery Lesions In Kawasaki Disease

Objective To explore the risk factors of kawasaki disease(KD) with coronary artery lesions(CAL) and evaluate the clinical application of osteoprotegerin(OPG) in predicting CAL.And appraise the feasibility and imaging quality of dual-source computed tomography angiography in patients with CAL by comparing the diagnostic accuracy between transthoracic echocardiagram(TTE) and dual-source computed tomography(DSCT).Method 90 patients diagnosed as KD were included in KD group,30 febrile patients(sex and age matched) with infective diseases in fever group,20 patients with sytemic lupus erythematousus(SLE) in SLE group and 30 health children in control group.Blood samples were collected for routine laboratory tests,including erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),white blood cell count(WBC),hemoglobin(HB),platelet count(PLT),serum albumin(ALB) and OPG concentration was detected in all subjects.The severity of coronary artery lesions was determined by the diameter of involved coronary artery.Statistics methods including t test,one way analysis of variates with LSD correction,liner regression and multivariate logistic regression were used to evaluate the mean differences of OPG among all groups.A receiver operating characteristic curve(ROC) was established for determination of optimal cutoff values of OPG,CRP and ALB for predicting the development of CAL.All 90 cases of KD accepted TTE examination,among which 15 cases accepted DSCT examination simultaneously.The results of echocardiogram and DSCT were analyzed by 2 adept radiological experts to appraise the superiority of DSCT in diagnosing CAL.Results The serum OPG level of patients in KD group is higher than that in fever group,SLE group and control group(p＜0.05).The serum OPG and CRP level is significantly higher in KD patients with CAL than those without CAL,and serum ALB level was lower.Multivariate logistic regression results showed that OPG,CRP and ALB were risk factors of CAL in KD patients.Serum OPG,CRP and ALB levels of patients with acute KD are all reliable indicators to predict CAL development by ROC analysis(p＜0.05).15 cases including 8 males and 7 females with average age of 3 years and 2 months old(range from 2 months to 11 years).51 coronary artery aneurysms were found by DSCT with maximum diameter of 1.55cm(0.52±0.31cm).23 aneurysms were small in size,20 aneurysms were medium and 8 aneurysms were giant ones. Among the 27 aneurysms in left coronary artery,13 were located in left main trunk,6 in proximal segment of left anterior descending branch(LAD),5 in medium segment of LAD and 3 in left circumflex branch.24 coronary artery aneurysms were located in right coronary artery,including 11 in proximal segment,7 in medium segment and 6 in distal segment.3 stenotic segments and 2 thrombus were found additionally.18 aneurysms located in medium or distal segments,3 stenosis and 2 thrombus were not revealed in echocardiography.Conclusion1.Serum OPG was increased and associated independently with CAL in patients with KD.2.Serum OPG,CRP and ALB were risk fators of CAL in patients with KD,and may help to predict CAL in acute phase of KD.3.DSCT could visualize clearly CAL in children,especially in detecting stenotic segments and thrombosis.DSCT was valuable for diagnosing CAL in chilren with KD.