Kawasaki Disease Coronary Artery Damage And Myocardial Injury Related Research

Objective:Kawasaki disease(KD) compicated with coronary artery lesior (CAL) and myocardial injury seriously threatens the survival and life quality o patients. It is becoming a leading cause of aquired heart disease in children i many nations. In the absence of specific diagnosis test or pathognomonic clinical feature, numerous studies were done try to find objective cliniaca parameter for early prediciting the risk of CAL and myocardial injury. The evidence revealed that EMC injury is the pathological base of aeteria coronaria expand and aeteria coronaria tumor and confined, while MMPs play important role in EMC's degradation. N-terminal pro-brain natriuretic peptideare (NT-proBNP) and Human Glycogen phosphorylase BB(GPBB) are two biochemical markers for prediction of myocardial damage to be find at present. The aim of this study was 1. to investigate the change in plasma NT-proBNP and GPBB in children with KD, examined the value of NT-proBNP and GPBB in the diagnosis of myocardial injury and explored the mechanism of the change in plasma NT-proBNP and GPBB in children with KD.2. to approach the expression level of MMP-20, TIMP-2 and MMP-2/TIMP-2 in peripheral blood of patient with Kawasaki disease and to investigate the impact of MMP-2 and TIMP-2 on aeteria coronaria injury in this course. Methods:A total of 40 patients with KD and 20 normal children were enrolled.in which there are 27 without CAL,and 13 with CAL. Test WBC,CRP,ESR,CtnI,CK-MB,PLT in acute stage, ELISA to test the protein level of MMP-2 and TIMP-2 in blood, and test the ratio of MMP-2and TIMP-2, using gelatin-zymography to test the activity of MMP-2 in serum, there are 20 normal children in control group, the ultrasound examination the day with KD patients, to test white blood cell count, C reactive protein and erythrocyte sedimentation rate, while detecting GBPP and NT-proBNP levels, MMP-2 and TIMP-2 protein levels MMP-2 activity in peripheral blood. Results:1. The mean plasma NT-proBNP concentration in patients with KD in the acute phase was (1306.55±658.08) ng/L, while it was (119.07±50.45) ng/L in normal children, the variance of two groups has statistical signific-ance (P< 0.01). The mean plasma NT-proBNP concentration in patiens with KD in the subacute phase was (388.43±228.67)ng/L, which is lower than the acute phase(P<0.01). In KD group, the level of plasma NT-proBNP of KD with CAL subgroup in acute phase was (1968.37±466.92)ng/L and it was (544.28+ 245.09)ng/L in KD with no CAL subgroup. There was significant difference in two subgroups (P<0.01).2. The mean plasma GPBB concentrations in patients with KD in the acute phase was(18.12±8.24)ng/L, and it was(8.28±3.99)ng/L in normal children. The plasma GPBB in patients with KD in the acute phase was significantly higher than that of control group(P<0.01). The mean plasma GPBB concentrations in patients with KD in the acute phase was (18.12±8.24)ng/L and it was (31.14±13.71)ng/L in subacute phase. The levels of plasma NT-proBNP increased significantly in subacute phase(P<0.01). In KD group, the levels of plasma GPBB of KD with CAL subgroup in acute phase was (26.04±5.81)ng/L and it was (12.84±4.50)ng/L in KD with no CAI subgroup. There was significant difference in two subgroups (P<0.01) The activity and protein level of MMP-2, TIMP-2 and MMP-2/TIMP-2 in serum for KD patients with CAL in acute stage was 11.49±4.01,675.4±171.6ng/ml,356.6±80.0ng/ml,1.96, while NCAL was 8.33±2.99,407.1±164. ng/ml,274.1±80.1ng/ml,1.61, the activety protein level of MMP-2 and that o TIMP-2 in the group with CAL was higher than that of the group NCAL(P<0.05). (2)the activity prote-in level of MMP-2 and TIMP-2 in fever group is 3.2±0.18,359.3±176.4ng/ml,247.7±89.7ng/ml,1.59, which was lower than KD patients(p<0.01). (3) the activity protein level of MMP-and TIMP-2 in normal group was 2.21±0.92,164.5±49.8ng/ml,130.1±43.2ng/ml,1.24, which was obviously lower than that of KD patients(p<0.01). (4)in the subacute stage and convalescence stage of KD, the activity protein level of MMP-2 and TIMP-2 was obviously lower than the acute stage(compare-ed with each stage in the same group P<0.01), but still higher than that of control group(P<0.05). While in the convalescence stage, the data of the three groups was near to the level of normal control group(P>0.05). Conclusion:1. The plasma NT-proBNP might be one of the useful biological markers of KD, and the mechanism of change in plasma NT-proBNP in KD might be associated with cardiac injury and change of ventricular wall stress. 2. there are many ways to test MMPs, of which ELISA has powerful discern specificity and high detect sensitivity, the minimal level can reach 1ng/ml. The activity protein level of MMP-2 and TIMP-2 are all obviously advanced in peripheral blood of KD patients, which reveal that MMP-2 make a role in the pathogenesy of KD, participate the degradation of aeteria coronaria's EMC, and lead to the reconstitution of blood vessel base, while TIMP-2 as MMP-2's inhibitor may participate the regulation of its activity, which relive aeteria coronana injury.