儿童川崎病冠状动脉并发症评价指标的对比分析

Analysis of different evaluation indicators of coronary artery complication among children with Kawasaki disease

目的比较传统的冠状动脉(冠脉)内径绝对值诊断标准和Z值法诊断标准在川崎病(Kawasaki disease,KD)合并冠脉扩张的检出率,为KD合并冠脉并发症的诊断提供依据。方法选取2017年1月至2018年2月于首都儿科研究所附属儿童医院心内科住院治疗的KD患者。分别依据1988年《中华儿科杂志》标准(1988年标准)、2015年第8版《诸福棠实用儿科学》标准(2015年标准)及2017年版《川崎病的诊断、治疗及远期管理—美国心脏学会对医疗专业人员的科学声明》推荐的2种Z值法(Kobayashi、Dallaire)诊断标准,计算KD合并冠脉并发症患儿的冠脉扩张检出率,并进行分析比较。结果 KD合并冠脉扩张患儿共89例。分别采用1988年标准、2015年标准及Z值法(Kobayashi、Dallaire标准),1岁以内小婴儿右冠状动脉扩张的检出率依次为53.85%、15.38%、26.92%、19.23%;其中1988年标准明显高于其他标准,差异有统计学意义(P<0.05);左冠状动脉扩张的检出率依次为34.62%、34.62%、42.31%、34.62%,Z值法(Kobayashi标准)冠脉扩张的检出率明显高于其余3种诊断标准,差异有统计学意义(P<0.05)。1岁以上患儿右冠状动脉扩张的检出率依次为25.40%、12.70%、12.70%、12.70%,其中1988年标准检出率高于其余各标准,差异有统计学意义(P<0.05);左冠状动脉扩张的检出率依次为17.46%、34.92%、14.29%、14.29%,其中2015年标准的检出率偏高,差异有统计学意义(P<0.05)。结论 1988年《中华儿科杂志》标准检出右冠状动脉扩张比例较高;2015年《诸福棠实用儿科学》标准在>1岁患儿组检出左冠状动脉扩张比例偏高;Z值法(Kobayashi、Dallaire标准)结合了患儿体格变化的影响,能较准确地反映川崎病合并冠脉并发症情况,2种Z值计算方法结果一致性好。

Objective To compare the different criteria for coronary artery abnormalities （CAA） in quantitative assessment of luminal dimensions and Z-scores so as to provide reliable evidences for diagnosis of coronary artery complications with Kawasaki disease （KD）. Methods Patients diagnosed KD in Department of Pediatric Cardiology, Children＇ s Hospital Capital Institute of Pediatrics were collected. Using the criteria for CAA with ＂Chinese Journal of Pediatrics＂ in 1988 （1988＇ s criteria）, eighth ＂Zhu Futang Shi Yong Er Ke Xue＂ in 2015 （2015＇ s criteria） and two kinds of Z score （Ko- bayashi, Dallaire） to acquire the positive ratio of CAA respectively. Results Eighty-nine KD patients with coronary artery complications were collected. According to 1988＇ s criteria, 2015＇ s criteria and two kinds of Z score （Kobayashi, Dallaire）, in children who were younger than one year old, the positive ratio of right CAA was 53.85%, 15.38%, 26.92%, 19.23% respectively. The positive ratio using 1988＇ s criteria was the highest （P 〈 0.05）. The positive ratio of left CAA was 34.62%, 34.62%, 42.31%, 34.62%. The positive ratio using Z score （Kobayashi） was the highest （P 〈 0.05）. In chil- dren who were older than one year old, the positive ratio of right CAA was 25.40%, 12.70%, 12.70%, 12.70% respectively. The positive ratio using 1988＇ s criteria was the highest （P 〈 0.05）. The positive ratio of left CAA was 17.46%, 34.92%, 14.29%, 14.29%, and the positive ratio using 2015＇ s criteria was the highest （P 〈 0.05）. Conclusion Considering the changes of body, Z score may accurately reflect the coronary artery complications among children with KD. It is good consistency in two kinds of calculating Z score.