剪切波弹性成像技术评估急性期川崎病患儿颈总动脉弹性的可行性

Feasibility of shear wave elastography in assessing elasticity of common carotid artery in children with acute Kawasaki disease

目的探讨剪切波弹性成像(SWE)技术评估急性期川崎病(KD)患儿颈总动脉弹性的可行性。方法选取2021年6月至2022年3月于电子科技大学医学院附属绵阳医院·绵阳市中心医院住院治疗的103例发热患儿,根据临床确诊结果将其分为KD组(n=68)和发热性疾病组(n=35),另选取同期性别、年龄相匹配的门诊健康体检儿童作为对照组(n=34)。比较3组儿童的实验室指标[白细胞计数(WBC)、C反应蛋白(CRP)、血小板计数(PLT)及白细胞介素-6(IL-6)]、颈总动脉后壁内中膜厚度(CIMT)、管腔横断面积、弹性模量最大值(Emax)和弹性模量平均值(Emean)。分析各实验室指标与Emean的相关性,评估颈总动脉Emean对急性期KD的诊断效能。结果3组儿童的血清WBC、PLT、CRP水平、IL-6水平比较,差异均有统计学意义(P﹤0.05)。KD组和发热性疾病组的血清WBC、PLT、CRP水平、IL-6水平均高于对照组(P﹤0.05);KD组的血清PLT、CRP水平、IL-6水平均高于发热性疾病组,血清WBC低于发热性疾病组(P﹤0.05)。KD组的Emax、Emean均高于发热性疾病组,发热性疾病组的Emax、Emean均高于对照组(P﹤0.05)。相关性分析结果显示,血清CRP、IL-6水平与Emean均呈正相关(r=0.536、0.622,P﹤0.05),血清WBC、PLT与Emean均无相关性(P﹥0.05)。受试者工作特征(ROC)曲线分析结果显示,当截断值取29.6 kPa时,颈总动脉Emean诊断急性期KD的灵敏度为73.50%,特异度为91.40%,AUC为0.92。结论SWE可有效评估急性期KD患儿颈总动脉的弹性,为KD患儿血管病变的临床诊断及鉴别诊断提供影像学参考依据。

Objective To investigate the feasibility of shear wave elastography(SWE)in assessing elasticity of the common carotid artery in children with acute Kawasaki disease(KD).Method A total of 103 children with fever who were hospitalized in the Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China from June 2021 to March 2022 were selected and divided into KD group(n=68)and febrile disease group(n=35)according to the clinical diagnosis results,and 34 health examination children from outpatient with gender and age matching were selected as the control group.The laboratory parameters[white blood cell(WBC)count,C-reactive protein(CRP),platelet(PLT)and interleukin-6(IL-6)],carotid intima-media thickness(CIMT),luminal transectional fracture area,elastic modulus maximum(Emax)and elastic modulus mean(Emean)of the three groups were compared.The correlation between laboratory indexes and Emean was analyzed to evaluate the diagnostic efficiency of common carotid artery Emean in acute KD.Result There were statistically significant differences for serum WBC,PLT,CRP level and IL-6 level in 3 groups(P<0.05);the serum WBC,PLT,CRP level and IL-6 level in the KD group and febrile disease group were higher than those in the control group;the serum PLT,CRP level and IL-6 level in the KD group were higher than those in the febrile disease group,while the serum WBC in the KD group was lower than those in the febrile disease group(P<0.05).Emax and Emean in KD group were higher than those in febrile disease group,and Emax and Emean in febrile disease group were higher than those in control group(P<0.05).Correlation analysis showed that serum CRP and IL-6 were positively correlated with Emean(r=0.536,0.622,P<0.05),while serum WBC and PLT were not correlated with Emean(P>0.05).Receiver operator characteristic(ROC)curve showed that when the truncation value was 29.6 kPa,the sensitivity of common carotid artery Emean in diagnosing acute KD was 73.50%,the specificity was 86.91%,and the AUC was 0.92,respectively.Conclusion SWE can effectively assess the elasticity of the common carotid artery in children with acute KD,and provide an effective imaging reference for clinical and differential diagnosis of KD.