川崎病冠状动脉瘤的2种超声心动图诊断方法分析

Analysis of 2 diagnostic criteria of echocardiography for coronary artery aneurysm in Kawasaki disease

目的分析Z值方法与传统方法对川崎病冠状动脉瘤(CAA)诊断的差异性,并探讨川崎病CAA的临床分布特点。方法回顾性分析2009年1月至2019年12月深圳市儿童医院风湿免疫科临床确诊的2419例川崎病患儿的临床及超声心动图资料。分别采用Z值方法和传统方法诊断CAA,分析2种诊断方法诊断效能的差异性;分别对患儿性别、临床分型(完全性川崎病、不完全性川崎病)、静脉注射免疫球蛋白(IVIG)治疗敏感性(IVIG敏感型川崎病、IVIG无应答型川崎病)、病程(≤6周、>6~8周、>8周至6个月)等进行分组,分析川崎病患儿CAA的临床分布特点。采用χ^(2)检验或秩和检验进行组间比较,Kappa检验用于一致性评价。结果2419例川崎病患儿中男1558例、女861例。发病年龄1.8(1.0,3.2)岁。Z值方法诊断川崎病CAA发生率高于传统方法[21.9%(529/2149)比13.9%(336/2149),χ^(2)=1074.94,P<0.001]。Z值方法诊断男性患儿、不完全性川崎病患儿、IVIG无应答型川崎病患儿CAA发生率均高于传统方法[25.2%(392/1558)比16.0%(249/1558)、32.7%(166/507)比19.5%(99/507)、30.5%(95/312)比24.0%(75/312),χ^(2)=694.05、216.19、184.37,均P<0.001]。Z值方法与传统方法诊断CAA具有较高的一致性(κ=0.642,P<0.001)。在Z值方法下CAA的发生率,男性(25.2%,392/1558)高于女性(15.9%,137/861)、不完全性川崎病(32.7%,166/507)高于完全性川崎病(19.0%,363/1912)、IVIG无应答型川崎病(30.4%,95/312)高于IVIG敏感型(20.6%,434/2107),差异均有统计学意义(χ^(2)=27.76、44.38、15.43,均P<0.001)。病程≤6周组冠状动脉Z值均大于病程>6~8周组和病程>8周至6个月组[1.3(0.7,2.3)比0.7(0.3,1.4)、0.7(0.3,1.3),Z=20.65、13.70,均P<0.001]。结论Z值方法诊断川崎病CAA的诊断发生率高于传统方法,川崎病CAA多发于病程6周内,男性、不完全性川崎病及IVIG无应答型川崎病CAA发生率较高。

Objective To analyze the difference between Z score and previous criteria in the diagnosis characteristics of coronary artery aneurysm(CAA)in Kawasaki disease,and to investigate the clinical distribution of Kawasaki disease CAA in the Z score group.Methods This study retrospectively analyzed the clinical and echocardiographic data of 2419 children with Kawasaki disease in Shenzhen Children′s Hospital from January 2009 to December 2019.The traditional criteria and Z score criteria were used to diagnose CAA,and the differences of diagnostic efficiency between the 2 diagnostic methods were analyzed.The clinical distribution characteristics of CAA in children with Kawasaki disease were analyzed by grouping their sex,clinical classification(complete Kawasaki disease,incomplete Kawasaki disease)the sensitivity to intravenous immunoglobulin(IVIG)(IVIG-sensitive Kawasaki disease,IVIG-unresponsive Kawasaki disease).And the course of the disease(≤6 weeks,>6-8 weeks,>8 weeks to 6 months)etc.Theχ^(2)test or Kruskal-Wallis test was used for comparison between the groups,and the Kappa test was used for consistency evaluation.Results Among the 2419 children with Kawasaki disease,1558 were males and 861 were females.The age of onset was 1.8(1.0,3.2)years.The rate of CAA by Z score criteria was higher than that by traditional method 21.9%(529/2419)vs.13.9%(336/2419,χ^(2)=1074.94,P<0.001).Compared to the traditional method,the Z score criteria found higher rate of CAA in male patients,patients with incomplete Kawasaki disease,and IVIG-unresponsive patients 25.2%(392/1558)vs.16.0%(249/1558), 32.7%(166/507)vs.19.5%(99/507),30.5%(95/312)vs.24.0%(75/312),(χ^(2)=694.05,216.19,184.37,all P<0.001).The Z score criteria was consistent with the traditional method in diagnosing CAA(κ=0.642,P<0.001).Moreover,in the Z score criteria,the rate of CAA in males(25.2%,392/1558)was higher than that in females(15.9%,137/861),higher in incomplete Kawasaki cases(32.7%,166/507)than that in complete Kawasaki case(19.0%,363/1912),and higher in IVIG-unresponsive cases(30.4%,95/312)than that in IVIG-sensitive cases(20.6%,434/2107),with statistically significant differences(χ^(2)=27.76,44.38,15.43,all P<0.001).Coronary Z score of course≤6 weeks was greater than that of course between>6-8 weeks and>8 weeks to 6 months1.3(0.7,2.3)vs.0.7(0.3,1.4),0.7(0.3,1.3),Z=20.65,13.70,both P<0.001.Conclusions The rate of CAA in Kawasaki disease by Z score criteria is higher than that by traditional method.In the Z score group,most CAA occur within 6 weeks of the course of the disease,and the rate of CAA in male,incomplete Kawasaki disease,and IVIG-unresponsive is higher.