川崎病患儿超声心动图冠状动脉内径Z值分析

Analysis of coronary artery Z-scores of children with Kawasaki disease on echocardiography

目的探讨超声心动图冠状动脉内径Z值定量川崎病(KD)冠状动脉病变的临床意义。方法回顾分析612例KD患儿急性期超声心动图冠状动脉内径及其临床表现。将冠状动脉内径转换为Z值,KD患儿按冠状动脉Z值的大小分为4组,无扩张组(ND)415例、小冠状动脉瘤组(SCAAs)133例、大冠状动脉瘤组(LCAAs)47例及巨大冠状动脉瘤组(GCAAs)17例,比较各组患儿间性别、年龄、典型病例比例、发热时间、实验室检查结果(C-反应蛋白、红细胞沉降率、白细胞、血小板),以及恢复期冠状动脉内径及其Z值变化。结果 ND组KD患儿发热天数为(7.75±3.12)d、SCAAs组为(8.50±4.12)d、LCAAs组为(8.57±3.58)d、GCAAs组为(11.88±4.33)d,各组KD患儿发热天数随冠状动脉Z值的增大有逐渐延长的趋势(F=22.375,P<0.05)。各组KD患儿C-反应蛋白、红细胞沉降率及白细胞比较,差异均无统计学意义(F=0.236、1.116、0.121,P均>0.05);但各组KD患儿血小板数量间差异有统计学意义,血小板数量随冠状动脉Z值增大有逐渐增多的趋势,以GCAAs组患儿的血小板数量最高(F=22.029,P=0.000)。与急性期比较,ND组的患儿在恢复期冠脉内径的差异无统计学意义[(2.24±0.34)mm vs(2.33±0.36)mm,t=1.926,P>0.05],但其Z值的比较(0.41±0.82 vs 1.17±0.75)结果显示差异有统计学意义(t=8.332,P<0.05);并且SCAAs组(1.32±0.89 vs 3.40±0.62)、LCAAs组(3.12±2.27 vs 6.20±1.28)、GCAAs组(11.88±6.77 vs20.4±9.70)冠状动脉内径Z值均比急性期减小,差异均有统计学意义(t=11.073、4.579、3.480,P均<0.05)。结论冠状动脉内径Z值是经体表面积校正的标准值,消除了病程中患儿年龄增长的因素,可准确反映KD冠状动脉病变的严重程度及其恢复期变化过程。根据患儿的年龄和身体大小准确定量冠状动脉内径对KD管理及评估预后具有重要意义。

Objective To investigate the clinical value of coronary artery Z-scores on echocardiography in diagnosing coronary artery abnormalities. Methods The echocardiography results of 612 patients with Kawasaki disease （KD） at the acute and recovery phase were retrospectively studied. Coronary artery luminal diameters were converted to body-surface-area-adjusted Z-scores. According to coronary Z-scores classiifcation, all the subjects were divided to four groups：415 cases with no dilation （ND）, 133 cases with small coronary artery abnormalities （SCAAs）, 47 cases with large coronary artery abnormalities （LCAAs）, and 17 cases with giant coronary artery abnormalities （GCAAs）. Clinical features （gender, age, typical clinical manifestations, fever duration） and laboratory results （CRP, ESR, WBC, PLT） were compared among all the four groups. Coronary artery diameters and the Z-scores were compared between acute and convalescence phase. Results Along with the increase of coronary Z-score, fever duration was prolonged [ND group：（7.75±3.12） d, SCAAs group （8.50±4.12） d, LCAAs group： （8.57±3.58） d, GCAAs group： （11.88±4.33） d, F=22.375, P〈0.05]. With coronary Z-score increasing, PLT also increased （F=22.029, P=0.000）, and the highest PLT was observed in GCAAs group. There were no significant differences in the CRP, ESR and WBC among all the four groups （F=0.236, 1.116, 0.121, all P＆gt;0.05）. No significant different coronary diameters were found in ND cases between recovery and acute phase [（2.24±0.34） mm vs （2.33±0.36） mm, t=1.926, P ＆gt; 0.05]. But there were significant difference in the coronary Z-scores of ND patients between recovery and acute phase （0.41±0.82 vs 1.17±0.75, t=8.332, P 〈 0.05）. The coronary Z-scores in SCAAs group （1.32±0.89 vs 3.40±0.62, t=11.073, P 〈 0.05）, LCAAs group （3.12±2.27 vs 6.20±1.28, t=4.579, P〈0.05） and GCAAs group （11.88±6.77 vs 20.4±9.70, t=3.480, P〈0.05） at recovery phase were smaller than values at acute phase. Conclusions The KD coronary Z-scores are the body-surface-area-adjusted standard value, and not subject to the influence of children growth and development. Therefore, it may accurately evaluate the severity of coronary artery abnormalities and its recovery process. Accurate quantitative of the coronary artery luminal dimensions is important in KD clinical management and prognosis prediction.