Z值对儿童川崎病冠状动脉病变的评估价值

Value of Z score in evaluating coronary artery lesions in children with Kawasaki disease

目的探讨Z值对儿童川崎病冠状动脉病变（CAL）的评估价值。方法收集2012年1月至2016年12月甘肃省人民医院儿科确诊的102例川崎病患儿的临床资料。超声心动图（ECHO）测量左冠状动脉主干（LMCA）和右冠状动脉（RCA）内径，初步判断CAL发病率。依据冠状动脉内径结果及患儿年龄、体表面积等个体化因素分别计算出左右冠状动脉的Z值，再次判断CAL发病率。结果102例患儿行ECHO检查发现CAL共22例（21.6%），其中LMCA病变18例（17.6%）, RCA病变22例（21.6%）。通过计算冠状动脉Z值发现CAL共33例（32.4%），其中LMCA病变29例（28.4%）, RCA病变33例（32.4%）。两种方法判断LMCA病变的发生率差异有统计学意义（χ^2＝3.35，P〈0.05）；两种方法判断RCA病变的发生率差异无统计学意义（χ^2＝3.01，P〉0.05）。说明Z值更能发现川崎病的冠状动脉损害情况，尤其是LMCA病变。对Z值最大的患儿行选择性冠状动脉血管造影检查发现有巨大冠状动脉瘤形成。结论在ECHO检查基础上计算冠状动脉Z值可广泛且简便地应用于临床上对CAL的评估，且Z值越大，CAL越严重。同时也可以指导治疗、判断预后及制定随访要求。

ObjectiveTo explore the clinical value of Z score in assessing coronary artery lesions （CAL） of children with Kawasaki disease.MethodsThe clinical records of 102 children with Kawasaki disease from January 2012 to December 2016 in Gansu Provincial Hospital were retrospectively analyzed.The internal diameter of left main coronary artery （LMCA） and right coronary artery （RCA） was measured by echocardiography （ECHO）, and the incidence of CAL was preliminarily judged.The Z scores of LMCA and RCA were calculated on the basis of the coronary artery diameter, the age of the children and the body surface area, and the incidence of CAL was judged again.ResultsA total of 22 cases（21.6%） of CAL were found in 102 cases by ECHO examination, of which 18 cases（17.6%） of LMCA lesions, and 22 cases（21.6%） of RCA lesions.A total of 33 cases（32.4%） of CAL were found by calculating the Z score of coronary artery, of which 29 cases（28.4%） of LMCA lesions and 33 cases（32.4%） of RCA lesions.There was significant difference between two methods for determining LMCA lesions （χ^2=3.35, P〈0.05）, and there was no significant difference between two methods for determining RCA lesions （χ^2=3.01, P〉0.05）. Z score of coronary artery was more accurate to detect the CAL in Kawasaki disease, especially LMCA lesions.A large coronary artery aneurysm was found in the patients with the largest Z score by selective coronary angiography.ConclusionThe Z score can be more conductive to assess the CAL in children with Kawasaki disease, and the higher the Z score, the more serious the CAL is.