Coronary Artery Dilatation And Endothelial Dysfunction Detected With Ultrasound Are Associated With Elevated Plasma Matrix Metalloproteinase (MMP)-2 Level In Children With Kawasaki Disease

Background Previous studies have shown that MMP-2 plays an important role in vascular remodeling and formation of aortic aneurysms in aortic bicuspid.However,its role in the formation of coronary artery dilation in Kawasaki disease(KD)is poorly understood.This study was aimed to explore the relationship between coronary artery dilation and endothelial function,and plasma MMP-2 level in children with KD.Methods A total of 90 children with KD and 20 healthy children with matched age and sex were included in the study.Conventional echocardiographic and coronary artery images were recorded by using two-dimensional transthoracic transducer.Endothelial function was assessed by measuring flow-mediated dilation(FMD)in the brachial artery in response to hyperemia with high-frequency linear array transducer.Analyze the images and measure relative parameters such as FMD,ejection fraction,and left ventricular internal dimension.Concentrations of plasma MMP-2,MMP-9 and tissue inhibitor of metalloproteinase(TIMP)-1 were determined by ELISA.The differences between multiple laboratory serum indicators and ultrasonographic parameters in Kawasaki disease group and normal control group were compared and correlation analysis was performed.Results During the laboratory examinations,the white blood cell count,platelet count and alanine transaminase content of KD patients were higher than that of the healthy control group(P<0.05),while the hemoglobin content and albumin content were significantly lower than those in the healthy subjects(P<0.001).The serum level of MMP-2 and TIMP-1 measured by KD group(without coronary artery lesions,CAL),CAL group and the healthy group were statistically different(F=5.9,P=0.004;F=29.3,P<0.001).And the MMP-2 level of CAL group was higher than that of control group(59.4±35.0 vs 34.7±20.2ng/ml,P=0.006)and KD group(59.4±35.0 vs 34.7±24.8ng/ml,P=0.003).Moreover,FMD results of KD children and normal children were statistically different(P<0.001).And it was still found that there was statistical difference in FMD results between healthy children and children more than one year after the onset of KD(5.8±1.6% vs 10.9±3.5%,P<0.001).As the interval prolonged,there was a tendency for endothelial function in children with KD to increase,but the results were not statistically different(P>0.05).Among those laboratory indexes above,only plasma MMP-2 levels were correlated with FMD results(P<0.001,r =-0.59).Conclusions Vascular endothelial function decreases in children with KD,and the coronary artery lesions and endothelial dysfunction may be associated with elevated plasma MMP-2 levels.