OBJECTIVE: To investigate the changes in the serum levels of oxidized phospholipids (OxPLs) and endothelial nitric oxide synthase (eNOS) and their association with coronary artery disease (CAL) in children in the acute stage of Kawasaki disease (KD), as well as the clinical significance of OxPLs and eNOS.
METHODS: A prospective study was conducted on 95 children in the acute stage of KD (KD group). According to the presence of absence of CAL, the KD group was further divided into a CAL subgroup and a non-CAL (NCAL) subgroup. Thirty children with fever due to lower respiratory tract infection were enrolled as the fever group. Thirty healthy children who underwent physical examination were enrolled as the healthy control group. The above groups were compared in terms of general information and serum levels of OxPLs, eNOS and other laboratory indexes, and the correlation between OxPLs level and eNOS level was analyzed.
RESULTS: The KD group had a significantly higher level of OxPLs and a significantly lower level of eNOS compared with the fever group and the healthy control group (P<0.05). After treatment, the children with KD had a significantly decreased OxPLs level and a significantly increased eNOS level (P<0.05). Compared with the NCAL subgroup, the CAL subgroup had a significantly higher level of OxPLs and a significantly lower level of eNOS (P<0.05). Among the children of KD, the level of OxPLs was negatively correlated with that of eNOS (rs=-0.353, P<0.05).
CONCLUSIONS: Serum OxPLs and eNOS in the acute stage of KD may be involved in the development of CAL in children with KD, and therefore, they may be used as the biomarkers to predict CAL in these children.
目的: 探讨川崎病（Kawasaki disease, KD）急性期患儿的血清氧化磷脂（oxidized phospholipids, OxPLs）和内皮一氧化氮合酶（endothelial nitric oxide synthase, eNOS）水平的变化，分析血清OxPLs和eNOS水平与冠状动脉病变（coronary artery lesion, CAL）的相关性，并探讨其临床意义。方法: 前瞻性选择95例急性期KD患儿作为KD组，根据是否合并CAL分为CAL亚组和非冠状动脉病变（non-coronary artery lesion, NCAL）亚组；另外选取同期30例仅下呼吸道感染发热患儿作为发热组，30例健康体检儿童作为健康对照组。比较各组一般资料及血清OxPLs、eNOS等实验室指标的差异，分析血清OxPLs和eNOS的相关性。结果: KD组OxPLs水平高于发热组及健康对照组（P<0.05），eNOS水平低于发热组及健康对照组（P<0.05）。KD患儿治疗后较治疗前血清OxPLs下降，血清eNOS上升（P<0.05）。CAL亚组血清OxPLs高于NCAL亚组（P<0.05），血清eNOS水平低于NCAL亚组（P<0.05）。KD组患儿OxPLs与eNOS水平呈负相关（rs=-0.353, P<0.05）。结论: KD急性期血清OxPLs、eNOS参与了CAL发展，可成为预测KD患儿发生CAL的生物标志物。.

OBJECTIVE: To evaluate the relationships between serum plasminogen activator (PA) and D-dimer levels, the severity of Kawasaki disease (KD) in children, and their ability to predict coronary artery lesions (CAL).
METHODS: This retrospective study analyzed the clinical data of 102 children diagnosed with KD at the Affiliated Hospital of Jiangnan University from January 2020 to September 2023. The cohort was divided into two groups: 31 children with CAL in the CAL group and 71 without it in the non-CAL group. The study assessed the incidence of CAL and investigated the correlations between serum PA and D-dimer levels and various inflammatory markers (white blood cell (WBC) count, platelet count, and erythrocyte sedimentation rate (ESR)). Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of these biomarkers for CAL.
RESULTS: CAL was present in 30.04% of the children. Pearson correlation analysis revealed that serum PA levels were inversely correlated with WBC count (P = 0.0187), platelet count (P = 0.0116), and ESR (P = 0.0041), while D-dimer levels were positively correlated with these markers (P < 0.001). A negative correlation between PA and D-dimer levels was also observed (P < 0.001). The combined use of PA and D-dimer levels to predict CAL achieved an area under the curve of 0.871.
CONCLUSIONS: Serum PA levels were negatively associated with the severity of KD, whereas D-dimer levels were positively associated. Together, these markers showed significant predictive value for CAL, highlighting their utility in assessing disease severity and guiding management in children with KD.

OBJECTIVE: The relationship between vitamin D status and Kawasaki Disease (KD), as well as coronary artery lesion (CAL), has yet to be established.
METHODS: A meta-analysis was conducted to assess the correlation between vitamin D status and KD, as well as the impact of vitamin D status on the progression of KD into CAL.
RESULTS: The meta-analysis revealed a consistent and significant association between serum 25(OH)D level and the occurrence KD (studies N = 22; z = -3.51, P < 0.001). Patients with KD had markedly lower levels of vitamin D than healthy controls (SMD: -1.30 ng/mL, 95%CI: -2.05 to -0.55 ng/mL).
CONCLUSIONS: The study provided evidence supporting a significant association between lower serum vitamin D levels and the occurrence of KD, particularly within the Chinese population. However, the findings did not suggest a direct impact of vitamin D on the development of CAL in KD patients.

UNASSIGNED: This systematic review and meta-analysis aimed to evaluate the relationship between the prognostic nutritional index (PNI) and intravenous immunoglobulin (IVIG) resistance and coronary artery lesion (CAL) in Kawasaki disease (KD).
UNASSIGNED: The relevant literature was searched on PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar up to August 5, 2023. A pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under curve (AUC) were calculated to assess the predicted values of PNI in KD patients with IVIG resistance and CAL.
UNASSIGNED: A total of 8 articles containing 10 studies involving 7,047 participants were included. The pooled results revealed a pooled sensitivity of 0.44 (0.25-0.65), a pooled specificity of 0.87 (0.73-0.94), a pooled PLR of 3.4 (2.0-5.9), a pooled NLR of 0.65 (0.48-0.87), a pooled DOR of 5.26 (2.76-10.02), and a pooled AUC of 0.75 (0.71-0.78) in the diagnosis of KD with CAL. The pooled results suggested that a pooled sensitivity was 0.69 (0.60-0.77), specificity was 0.76 (0.69-0.82), PLR was 2.9 (2.1-4.1), NLR was 0.40 (0.29-0.56), DOR was 7.27 (3.89-13.59), and AUC was 0.79 (0.75-0.82) in the diagnosis of KD with IVIG resistance. The combined results revealed the pooled sensitivity was 0.63 (0.58-0.67), specificity was 0.82 (0.80-0.83), PLR was 3.09 (1.06-8.98), NLR was 0.38 (0.07-2.02), DOR was 8.23 (0.81-83.16) in differentiating KD from febrile patients. These findings demonstrated low sensitivity and relatively high specificity of PNI for KD, KD-CAL, and IVIG-resistant KD.
UNASSIGNED: In conclusion, this study was the first systematic review and meta-analysis of the diagnostic value of PNI in KD with IVIG resistance and CAL. The results suggested that PNI could be used as biomarkers for distinguish KD, KD with CAL, and KD with IVIG resistance.

OBJECTIVE: The aim of this study was to identify the prevalence and anatomic characteristics of coronary artery lesions and their associated postoperative risk in patients undergoing supravalvular aortic stenosis repair.
METHODS: The association between structural risk factors, postoperative ST-segment changes, and major adverse cardiac events was explored using logistic regression and the Fisher\'s exact test.
RESULTS: In 51 consecutive patients with supravalvular aortic stenosis treated between 2000 and 2017, a total of 48 coronary lesions were identified in 27 patients (53%). Prominent ostial ridge (type I) was the most common coronary lesion, followed by small ostium with (IIIb) or without (IIIa) diffuse long-segment coronary narrowing, and adhesion of the coronary cusp (type II). There were 54 concomitant coronary procedures, including 43 primary corrections and 11 revisions. Thirty-three patients underwent supravalvular aortic stenosis repair with a bifurcated patch, of which 13 (39.4%) had right coronary artery distortion/kinking requiring patch plication (n = 8) and reimplantation (n = 5). Postoperative major adverse cardiac events (MACE) occurred in 9 patients (17.6%), including 3 deaths, 4 needing mechanical circulatory support, and 6 experiencing ventricular arrhythmias. Twenty-two patients (43.1%) had postoperative ST-segment changes, including 13 early changes that resolved within 24 h and 9 persistent changes lasting >24 h. Patients with type III lesions were associated with postoperative persistent ST-segment change (P = 0.04) and these lesions independently predicted postoperative MACE (P = 0.02). Patients with pre-existing coronary lesions were at elevated risk of right coronary artery distortion/kinking (P = 0.045).
CONCLUSIONS: The prevalence of ST-segment changes and MACE is high in patients undergoing supravalvular aortic stenosis repair. The preoperative presence of complex coronary lesions is the most important predictor for postoperative major adverse cardiac events.

UNASSIGNED: Coronary artery lesions (CALs) are a major complication of Kawasaki disease (KD); however, data on CAL incidence and risk factors in recurrent KD are limited.
UNASSIGNED: Ninety-seven children with recurrent KD were retrospectively enrolled from 2013 to 2022, and CAL incidence was tracked during admission, discharge, and during follow-up.
UNASSIGNED: Initially, 27.8% had CAL at admission and discharge, declining to 7.2% at 12 months post-discharge. Most patients (66 of 97, 68.0%) did not exhibit CAL at any of the time points, 7 cases presented CAL at all time points, indicating a persistent CAL. The remaining 20 cases presented CAL at admission but recovered at discharge or during follow-up. Notably, transient CALs had presented at discharge, or during the follow-up, but finally resolved at 12 months after discharge. Notably, prior IVIG resistance and increased prothrombin time seemed associated with CAL in recurrent KD, suggesting they could help identify patients needing close monitoring.
UNASSIGNED: The study highlights decreasing CAL incidence over time in recurrent KD but with diverse patterns, emphasizing the importance of monitoring and further investigations to confirm these findings.

Kawasaki disease (KD) is a systemic inflammatory vascular disorder that predominantly affects children and is the leading cause of acquired heart disease in children. Although the etiology of this disease remains unclear, genome-wide association and genome-wide linkage studies have shown that some susceptible genes and chromosomal regions are associated with the development and progression of KD. With the advancement of high-throughput DNA sequencing techniques, more and more genomic information related to KD is being discovered. Understanding the genes involved in the pathogenesis of KD may provide novel insights into the diagnosis and treatment of KD. By analyzing related articles and summarizing related research advances, this article mainly discusses the T cell activation-enhancing genes that have been confirmed to be closely associated with the development and progression of KD and reveals their association with the pathogenesis of KD and coronary artery lesions.
川崎病（Kawasaki disease, KD）是一种好发于儿童的全身性血管炎症疾病，是儿童后天性心脏病的主要原因。虽然该病病因尚不清楚，但通过全基因组关联和全基因组连锁研究发现，一些易感基因和染色体区域与KD的发生发展相关。随着高通量DNA测序技术的发展，越来越多与KD相关的基因组信息被发现。了解KD发病机制中涉及的基因可能为该病的诊断和治疗提供新思路。该文通过分析相关文献，总结研究进展，主要讨论目前已证实与KD发生发展密切相关的增强T细胞活化类基因，揭示其与KD发病及冠状动脉损伤的相关性。.

OBJECTIVE: To explore the role and potential mechanisms of chitinase-3-like protein 1 (CHI3L1) in coronary artery lesions in a mouse model of Kawasaki disease (KD)-like vasculitis.
METHODS: Four-week-old male SPF-grade C57BL/6 mice were randomly divided into a control group and a model group, with 10 mice in each group. The model group mice were intraperitoneally injected with 0.5 mL of lactobacillus casei cell wall extract (LCWE) to establish a mouse model of KD-like vasculitis, while the control group mice were injected with an equal volume of normal saline. The general conditions of the mice were observed on the 3rd, 7th, and 14th day after injection. Changes in coronary artery tissue pathology were observed using hematoxylin-eosin staining. The level of CHI3L1 in mouse serum was measured by enzyme-linked immunosorbent assay. Immunofluorescence staining was used to detect the expression and localization of CHI3L1, von Willebrand factor (vWF), and α-smooth muscle actin (α-SMA) in coronary artery tissue. Western blot analysis was used to detect the expression of CHI3L1, vWF, vascular endothelial cadherin (VE cadherin), Caspase-3, B cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), nuclear factor κB (NF-κB), and phosphorylated NF-κB (p-NF-κB) in coronary artery tissue.
RESULTS: The serum level of CHI3L1 in the model group was significantly higher than that in the control group (P<0.05). Compared to the control group, the expression of CHI3L1 in the coronary artery tissue was higher, while the expression of vWF was lower in the model group. The relative expression levels of CHI3L1, Bax, Caspase-3, NF-κB, and p-NF-κB were significantly higher in the model group than in the control group (P<0.05). The relative expression levels of vWF, VE cadherin, and Bcl-2 were lower in the model group than in the control group (P<0.05).
CONCLUSIONS: In the LCWE-induced mouse model of KD-like vasculitis, the expression levels of CHI3L1 in serum and coronary arteries increase, and it may play a role in coronary artery lesions through endothelial cell apoptosis mediated by inflammatory reactions.
目的: 探究壳多糖酶3样蛋白1（chitinase-3-like protein 1, CHI3L1）在川崎病（Kawasaki disease, KD）样血管炎小鼠模型冠状动脉损伤中的作用及其潜在机制。方法: 将4周龄雄性SPF级C57BL/6小鼠随机分为正常对照组和模型组，每组10只。模型组小鼠通过腹腔注射干酪乳杆菌细胞壁提取物（lactobacillus casei cell wall extract, LCWE）0.5 mL构建KD样血管炎小鼠模型，对照组腹腔注射等量的生理盐水。注射后第3天、第7天和第14天观察小鼠的一般情况。采用苏木精-伊红染色法观察冠状动脉组织病理学变化。采用酶联免疫吸附法检测小鼠血清中CHI3L1水平。采用免疫荧光染色法检测CHI3L1、血管性血友病因子（von Willebrand factor, vWF）、α-平滑肌肌动蛋白（α-smooth muscle actin, α-SMA）在冠状动脉组织中的表达及定位。采用Western blot法检测冠状动脉组织中CHI3L1、vWF、血管内皮钙黏蛋白（vascular endothelial cadherin, VE cadherin）、半胱天冬酶-3（Caspase-3）、B细胞淋巴瘤-2（B cell lymphoma-2, Bcl-2）、Bcl-2相关X蛋白（Bcl-2 associated X protein, Bax）、核转录因子κB（nuclear factor-κB, NF-κB）及磷酸化NF-κB（p-NF-κB）表达情况。结果: 模型组小鼠血清中CHI3L1含量较对照组明显升高（P<0.05）。与对照组相比，模型组小鼠冠状动脉组织中CHI3L1表达高于对照组，vWF表达低于对照组。模型组小鼠CHI3L1、Bax、Caspase-3、NF-κB及p-NF-κB蛋白相对表达量明显高于对照组（P<0.05）。模型组vWF、VE cadherin和Bcl-2蛋白相对表达量低于对照组（P<0.05）。结论: LCWE诱导的KD样血管炎小鼠模型中，血清及冠状动脉CHI3L1的表达水平升高，可能通过炎性反应介导血管内皮细胞凋亡在冠状动脉损伤中发挥作用。.

OBJECTIVE: To systematically evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting coronary artery lesions (CAL) in Chinese children with Kawasaki Disease (KD).
METHODS: A comprehensive search was conducted in databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database from inception to December 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale, and a Meta analysis was performed using Stata 15.1.
RESULTS: A total of ten published reports, involving 3 664 Chinese children with KD, were included in this Meta analysis, of whom 1 328 developed CAL. The Meta analysis revealed a sensitivity of 0.78 (95%CI: 0.71-0.83), specificity of 0.71 (95%CI: 0.61-0.80), overall diagnostic odds ratio of 8.69 (95%CI: 5.02-15.06), and an area under the curve of the summary receiver operating characteristic of 0.82 (95%CI: 0.78-0.85) for PLR in predicting CAL in the children with KD. The sensitivity, specificity, and area under the curve of summary receiver operating characteristic were lower for PLR alone compared to PLR in combination with other indicators. Sensitivity analysis demonstrated the stability of the Meta analysis results with no significant changes upon excluding individual studies. However, a significant publication bias was observed (P<0.001).
CONCLUSIONS: PLR demonstrates certain predictive value for CAL in Chinese children with KD.
目的: 系统评价血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）对川崎病（Kawasaki disease, KD）患儿冠状动脉病变（coronary artery lesion, CAL）的预测价值。方法: 检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据、中国生物医学文献检索数据库、维普数据库等数据库自建库至2022年12月PLR预测中国KD患儿发生CAL的相关研究。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评价纳入文献的质量，采用Stata 15.1进行Meta分析。结果: 共纳入10项研究，包括3 664例中国KD儿童，其中1 328例发生了CAL。Meta分析显示：PLR预测KD患儿发生CAL的灵敏度为0.78（95%CI：0.71~0.83），特异度为0.71（95%CI：0.61~0.80），总诊断比值比为8.69（95%CI：5.02~15.06），拟合受试者操作特征的曲线下面积为0.82（95%CI：0.78~0.85）。亚组分析显示，单独使用PLR预测KD患儿发生CAL的灵敏度、特异度和曲线下面积低于PLR联合其他指标。敏感性分析显示，逐一排除纳入研究后结果无显著变化，提示Meta分析结果稳健。发表偏倚结果显示，纳入的研究存在显著的发表偏倚（P<0.001）。结论: PLR对中国KD患儿CAL的发生有一定的预测价值。.

UNASSIGNED: To investigate the correlation between FGA gene polymorphisms and coronary artery lesion in Kawasaki disease.
UNASSIGNED: Two hundred and thirty four children with Kawasaki disease (KD group), 200 healthy children (normal group) and 208 children with non-KD fever (fever group) were enrolled. General clinical indicators, the concentration of serum MMPs, TIMP-1, FG-α,fibrinogen level, molecular function (FMPV/ODmax) and FGA Thr312Ala polymorphism were detected individually by testing peripheral venous blood after fasting in the morning.
UNASSIGNED: There was no significant difference in average age among the three groups, which were 3.03 ± 1.22 years, 3.17 ± 1.30 years, and 3.21 ± 1.31 years, respectively. Compared with those in the fever group, the levels of white blood cell count (WBC), platelet count (PLT), procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and fibrinogen (Fg) levels were significantly increased in the KD group. Red blood cell count (RBC) and hemoglobin (Hb) levels were significantly decreased (p < 0.05).The concentration of serum MMPs, TIMP-1, and FG-α in the KD and fever groups were significantly higher than those in the normal group (p < 0.05). The concentration of MMP-2, MMP-3, MMP-9, MMP-13, TIMP-1, and FG-α in the KD group were significantly higher than those in the fever group (p < 0.05).The KD group was divided into two subgroups,55 patients with combined CAL and 179 patients without combined CAL. The plasma fibrinogen concentration in the combined CAL group was significantly higher than that in the non-combined CAL and normal groups (p < 0.01). There was no statistically significant difference in FMPV/ODmax among the three groups (p > 0.05). Compared with normal group, the FGA GG, GA, and AA genotype and G, A allele frequency of the FGA gene polymorphism in the KD group showed no significant difference (p > 0.05). In the KD group, the most common type in children with CAL was GA, while the most common type in children without CAL was GG.
UNASSIGNED: MMPs and FG-α were significantly upregulated in KD patients. The proportion of FGA genotype GA in children with CAL was significantly higher than that in children without CAL, suggesting that FGA gene polymorphisms affect coronary artery lesion in children with KD.