RESUMO
Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which differ in size and emergence time, and track its regression within 3 years of onset. The laboratory data, clinical features, and coronary artery outcomes of patients, who were diagnosed with KD and received treatment from January 2003 to January 2019 were retrospectively analyzed. A total of 484 pediatric patients with KD were examined during the study period. Among them, 130 (26.9%) presented with CAA, including mid- to large-sized CAA in 38 patients (7.9%) and de novo CAA after intravenous immunoglobulin (IVIG) treatment in 22 patients (4.5%). Albumin-to-globin (A/G) ratio was significantly negatively associated with the absolute internal diameter of coronary artery at 1 month of onset and may be used as a predictor of mid- to large-sized CAA development in patients with KD. The area under the receiver operating characteristic curve was 0.637 (95% confidence interval: 0.551-0.724), and a cutoff of 1.32 yielded a sensitivity and specificity of 79 and 49%, respectively, for predicting mid- to large-sized CAA development. De novo CAA after IVIG may lead to an increased risk of developing progressive CAA [13 (59.1%) of 22 vs. 31 (28.7%) of 108; P = 0.006] and had significantly greater changes in both the magnitude of CAA dimension variation and maximum z-score of the coronary arteries at 2 and 4 weeks and then 3 months after onset (P < 0.001). Kaplan-Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in the progressive CAA group than in the non-progressive CAA group (25 vs. 4 months, P < 0.001), as well as among the three groups of patients (giant CAA > medium-sized CAA > small-sized CAA, P < 0.001). Children with KD who had low A/G ratio were more likely to develop mid- to large-sized CAA. Nevertheless, de novo CAA after IVIG treatment may increase the risk of more severe arterial damage and development of progressive coronary artery damage; and both mid- to large-sized and de novo CAA could dramatically prolong coronary artery normalization time. Thus, aggressive risk modifications should be employed, and close monitoring with frequent echocardiography is needed for this vulnerable patient population.
RESUMO
A flow injection solid-phase extraction preconcentration system using a multi-walled carbon nanotubes (MWCNTs) packed micro-column was developed for the determination of 16 polycyclic aromatic hydrocarbons (PAHs) in water by gas chromatography-mass spectrometry (GC-MS). The preconcentration of PAHs on the MWCNTs was carried out based on the adsorption retention of analytes by on-line introducing the sample into the micro-column system. Methanol was introduced to elute the retained analytes for GC-MS analysis using selected ion monitoring (SIM) mode. Important influence factors were studied in detail, such as sample acidity, sample flow rate, eluent flow rate and volume, dimensions of MWCNTs and amounts of packing material. Limits of detection of 16 PAHs for an extraction of 50 mL water sample were in the range of 0.001-0.15 microg L(-1), and the precisions (RSD) were in the range of 4-14%. The optimized method was successfully applied to the determination of 16 PAHs in surface waters, with recoveries in the range of 72-93% for real spiked sample.