Abstract
BackgroundOxidative stress has recently been shown to play an important role in the development of arteriosclerosis in patients with Kawasaki disease (KD); however, no study has investigated this association in early childhood patients with KD. In this study, we evaluated prospectively the association between the levels of oxidative stress and the endothelial function in early childhood patients with KD.MethodsWe compared the derivatives of reactive oxygen metabolites (ROM), flow-mediated dilatation (FMD), and biological characteristics in a population of 50 children: 10 patients with KD and coronary artery lesions (CAL) (group 1), 15 KD patients without CAL (group 2), and 25 healthy age- and sex-matched children (group 3).ResultsThe median age of all KD children at study enrollment was 6.8 (IQR 4.4–8.2) years. ROM levels were significantly higher in group 1 (p < 0.001) and group 2 (p = 0.004) than in group 3. The %FMD of group 1 (p < 0.001) and group 2 (p = 0.026) was significantly lower than that of group 3. There was a significant negative correlation between ROM and %FMD (r = − 0.60, p < 0.001). A multiple linear regression analysis identified ln-ROM (standardized coefficient = − 0.403, p = 0.043) and total fever duration (standardized coefficient = − 0.413, p = 0.038) as significant determinants of %FMD in the patients with KD.ConclusionsOur study suggests that oxidative stress is strongly associated with endothelial dysfunction in early childhood patients with KD. Furthermore, we found that the longer the fever duration, the higher the risk of oxidative stress-induced endothelial dysfunction in these children.
Highlights
Oxidative stress has recently been shown to play an important role in the development of arteriosclerosis in patients with Kawasaki disease (KD); no study has investigated this association in early childhood patients with KD
Of the 25 KD patients, 18 children completely responded to a single intravenous immunoglobulin (IVIG) therapeutic session, and seven patients required a second dose of IVIG because of a persistent fever; of these seven patients, six failed to respond to the second IVIG therapy session
We found that the number of days with a fever before diagnosis, total fever duration, C-reactive protein (CRP) levels, and ln-reactive oxygen metabolites (ROM) inversely correlated with %flow-mediated dilatation (FMD)
Summary
Oxidative stress has recently been shown to play an important role in the development of arteriosclerosis in patients with Kawasaki disease (KD); no study has investigated this association in early childhood patients with KD. Endothelial dysfunction is one of the earliest manifestations of arteriosclerosis [1, 2] and has been demonstrated in KD children with or without coronary artery lesions (CAL) after acute illness [3, 4]. While these mounting evidences suggest that there is premature arteriosclerosis in patients with a history of KD, the underlying mechanisms are still undefined. The derivatives of reactive oxygen metabolites (ROM) test, which mainly consists of measuring hydroperoxide levels as a marker of ROS, has been used to directly assay the total oxidant capacity [7,8,9]
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