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| Case analysis of infectious mononucleosis with coronary artery dilatation |
| LIU Jingjing1 ZHENG Chunhua2 LI Xiaohui1 BAO Min2 CAO Aimei2 REN Jun2 LIU Bo2 LIU Yan2 |
1.Department of Cardiology, Children′s Hospital, Capital Institute of Pediatrics, Beijing 100020, China;
2.Department of Ultrasonic Cardiogram, Children′s Hospital, Capital Institute of Pediatrics, Beijing 100020, China |
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Abstract Objective To investigate the clinical characteristics of coronary artery dilatation (CAD) of children with infectious mononucleosis (IM). Methods From May 2015 to December 2016, the cases diagnosed with IM in Children's Hospital, Capital Institute of Pediatrics were collected and performed echocardiogram. Z value was used to estimate CAD. The clinical characteristics of IM with CAD were analyzed. Results ①Clinical features: 15 children (8 boys and 7 girls) of IM with CAD among totally 344 patients were included in this study. The incidence of IM with CAD was about 4.4%. The mean age was (3.47±1.61) years. The most common clinical manifestation included fever (15 cases, 100.0%), and lymph nodes enlargement (14 cases, 93.3%). Blood routine showed leukocytosis (14 cases, 93.3%), high lymphocyte proportion (15 cases, 100.0%) and increased atypical lymphocyte ratio (14 cases, 93.3%). The disorder of cell-mediated immunity was found in 14 cases (93.3%). ②Coronary artery: the median time of CAD was 5 (4, 8) d. The median duration of CAD was 17 (7, 41) d. The median Z-score of coronary artery was 3.74 (3.01, 5.64). The right CAD was found in 13 cases (86.7%). Conclusion CAD in patients with IM can develop within 1 week after onset, and persist for about 2-3 weeks. The right CAD is the most common finding, and the prognosis is good.
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[1] Abou SS，Ozden TO，Taskoylu O，et al. Coronary Artery Aneurysms：A Review of the Epidemiology，Pathophysiology，Diagnosis，and Treatment [J]. Front Cardiovasc Med，2017，4：24.
[2] 李国民，顾绍庆，王锁英，等.急性EB病毒感染致冠状动脉扩张1例报告并文献复习[J].临床儿科杂志，2009， 27（9）：853-855.
[3] 石莹，王新宝.EB病毒感染再激活合并冠状动脉扩张[J].中国医刊，2015，50（12）：9-11.
[4] 王群，谢正德.儿童EB病毒相关疾病的诊断标准和治疗原则[J].实用儿科临床杂志，2010，25（10）：706-708.
[5] Dunmire SK，Hogquist KA，Balfour HH. Infectious Mononucleosis [J]. Curr Top Microbiol Immunol，2015，390（Pt 1）：211-240.
[6] 胡群，张小玲.噬血细胞综合征诊断指南（2004）[J].实用儿科临床杂志，2008，23（3）：235-236.
[7] 段红梅，申昆玲.慢性活动性EB病毒感染的诊断标准和治疗[J].实用儿科临床杂志，2006，21（10）：638-640.
[8] 夏焙，许娜，何学智，等.儿童超声心动图冠状动脉正常参考值及临床意义[J].中华医学超声杂志：电子版，2013， 10（1）：42-51.
[9] Binkley PF，Cooke GE，Lesinski A，et al. Evidence for the role of Epstein Barr Virus infections in the pathogenesis of acute coronary events [J]. PLoS One，2013，8（1）：e54008.
[10] Ariza ME，Glaser R，Kaumaya PT，et al. The EBV-encoded dUTPase activates NF-kappa B through the TLR2 and MyD88-dependent signaling pathway [J]. J Immunol，2009，182（2）：851-859.
[11] Dogan A，Tuzun N，Turker Y，et al. Matrix metalloproteinases and inflammatory markers in coronary artery ectasia： their relationship to severity of coronary artery ectasia [J]. Coron Artery Dis，2008，19（8）：559-563.
[12] Waldman WJ，Williams MJ，Lemeshow S，et al. Epstein-Barr virus-encoded dUTPase enhances proinflammatory cytokine production by macrophages in contact with endothelial cells：evidence for depression-induced atherosclerotic risk [J]. Brain Behav Immun，2008，22（2）：215-223.
[13] Yilmaz H，Tayyareci G，Sayar N，et al. Plasma soluble adhesion molecule levels in coronary artery ectasia [J]. Cardiology，2006，105（3）：176-181.
[14] Lu TP，Chuang NC，Cheng CY，et al. Genome-wide methylation profiles in coronary artery ectasia [J]. Clin Sci（Lond），2017，131（7）：583-594.
[15] Shimizu T，Kida Y，Kuwano K. Cytoadherence-dependent induction of inflammatory responses by Mycoplasma pneumoniae [J]. Immunology，2011，133（1）：51-61.
[16] Knight DA，Waldman WJ，Sedmak DD. Cytomegalovirus-mediated modulation of adhesion molecule expression by human arterial and microvascular endothelial cells [J]. Transplantation，1999，68（11）：1814-1818.
[17] Binstadt BA，Levine JC，Nigrovic PA，et al. Coronary artery dilation among patients presenting with systemic-onset juvenile idiopathic arthritis [J]. Pediatrics，2005， 116（1）：e89-e93.
[18] Muniz JC，Dummer K，Gauvreau K，et al. Coronary artery dimensions in febrile children without Kawasaki disease [J]. Circ Cardiovasc Imaging，2013，6（2）：239-244.
[19] Mccrindle BW，Rowley AH，Newburger JW，et al. Diagnosis，Treatment，and Long-Term Management of Kawasaki Disease：A Scientific Statement for Health Professionals From the American Heart Association [J]. Circulation，2017，135（17）：e927-e999.
[20] 陈春法，张文喜，赵佳佳，等.传染性单核细胞增多症患儿血淋巴细胞亚群及NK细胞的变化分析[J].中华医院感染学杂志，2016，26（20）：4727-4729.
[21] Ding Y，Li G，Xiong LJ，et al. Profiles of responses of immunological factors to different subtypes of Kawasaki disease[J]. BMC Musculoskelet Disord，2015，16（1）：315. |
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