冠脉Z值联合Kobayashi风险评分系统在诊断川崎病冠脉损害中的应用

doi:10.7517/issn.1674-0475.221029

摘要/Abstract

摘要： 本文探讨冠脉Z值联合Kobayashi风险评分系统评估川崎病冠脉损害的价值。选取108例川崎病（KD）患儿作为研究对象，最终确诊冠脉无扩张患儿68例，纳入无损害组，损害组40例，包括仅冠状动脉扩张患儿10例，小型冠状动脉瘤患儿11例，中型冠状动脉瘤患儿9例，大型冠状动脉瘤患儿10例。比较无损害组和损害组患儿临床资料、冠脉Z值及Kobayashi评分差异。损害组的年龄≤1岁、发热持续时间≥10 d、不完全性川崎病、延迟诊治和Kobayashi评分>3分比例高于无损害组（P<0.05）。Logistic回归分析结果显示：年龄、发热持续时间、诊治时间和Kobayashi评分是川崎病患儿发生冠脉损害的影响因素（P<0.05）。中型冠状动脉瘤/大型冠状动脉瘤患儿的左侧冠状动脉主干内径Z值、左前降支内径Z值、右冠脉近段内径Z值均高于无扩张和仅冠状动脉扩张/小型冠状动脉瘤患儿（P<0.05）。中型冠状动脉瘤/大型冠状动脉瘤患儿的Kobayashi评分>3分比例高于无扩张患儿（P<0.05）。冠脉Z值联合Kobayashi评分诊断中型冠状动脉瘤/大型冠状动脉瘤的ROC曲线下面积较高。川崎病冠脉损害发生受患儿年龄、发热持续时间、诊治时间和Kobayashi评分等因素的影响，冠脉Z值联合Kobayashi评分在诊断冠脉损害严重程度方面有一定应用价值。

关键词: 冠状动脉, Z值, Kobayashi风险评分, 川崎病, 冠脉损害

Abstract: This paper investigated the value of coronary Z-value combined with Kobayashi risk score system in evaluating coronary artery damage in Kawasaki disease(KD). 108 children with KD were selected as the research objects, and 68 children without coronary artery dilatation were finally diagnosed and included in the non-damage group. There were 40 patients in the damaged group, including 10 children with only coronary artery dilatation, 11 children with small coronary artery aneurysm, 9 children with medium coronary artery aneurysm, and 10 children with large coronary artery aneurysm. The proportion of clinical data, coronary Z-value and Kobayashi score were compared between the two groups. The proportions of age ≤ 1 year, fever duration ≥ 10 days, incomplete KD, delayed diagnosis and treatment, and Kobayashi score > 3 in the damage group were higher than those in the non-damage group (P<0.05). Logistic regression analysis showed that age, fever duration, diagnosis and treatment time and Kobayashi score were the influencing factors of coronary artery damage in children with KD (P<0.05). The Z-value of the left main coronary artery diameter, the Z-value of the left anterior descending coronary artery diameter, and the Z-value of the right proximal coronary artery diameter in children with medium/large coronary artery aneurysm were higher than those in children with no dilatation and only coronary artery dilatation/small coronary artery aneurysm (P<0.05). The proportion of Kobayashi score > 3 in children with medium/large coronary aneurysms was higher than that in children without dilatation (P<0.05). The area under the ROC curve of coronary Z-value combined with Kobayashi score in the diagnosis of medium coronary aneurysms/large coronary aneurysms was high. The incidence of coronary artery damage in Kawasaki disease is affected by age, fever duration, diagnosis and treatment time, Kobayashi score and other factors. Coronary Z-value combined with Kobayashi score has certain application value in diagnosing the severity of coronary artery damage.

Key words: coronary artery, Z-value, Kobayashi risk score, Kawasaki disease, coronary artery damage

黄葆莹, 蒋苏华, 彭伟彬, 蒋威. 冠脉Z值联合Kobayashi风险评分系统在诊断川崎病冠脉损害中的应用[J]. 影像科学与光化学, 2023, 41(1): 38-42.

HUANG Baoying, JIANG Suhua, PENG Weibin, JIANG Wei. Application of Coronary Z-value Combined with Kobayashi Risk Score System in the Diagnosis of Coronary Artery Damage in Kawasaki Disease[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(1): 38-42.

参考文献

[1] 徐春辉, 杨静, 刘鹏. 超声心动图在小儿川崎病冠状动脉病变诊断及随访中的应用价值[J]. 中国优生与遗传杂志, 2020, 28(10):1282-1284.
[2] Yang M L, Pei Q F, Zhang J, et al. Association between adropin and coronary artery lesions in children with Kawasaki disease[J]. European Journal of Pediatrics, 2021, 180(7):2253-2259.
[3] Wang Z, Liu X H, Duan Z, et al. High serum total IgE at admission is associated with coronary artery lesions in children with Kawasaki disease[J]. Journal of Tropical Pediatrics, 2022, 68(1):fmab113.
[4] Danchin M H, Abo Y, Akikusa J, et al. FDG-PET imaging in a child with Kawasaki disease:Systemic and coronary artery inflammation without dilatation[J]. Archives of Disease in Childhood, 2022, 107(6):619-621.
[5] 朱丹颖, 宋思瑞, 张晗, 等. 川崎病丙种球蛋白无反应评分模型的建立与研究[J]. 国际儿科学杂志, 2018, 45(7):532-536, 542.
[6] 赵杨, 刘俐. 川崎病心血管后遗症的超声应用进展[J]. 海南医学, 2022, 33(16):2158-2161.
[7] 骆盼, 李金玲, 柳成良. CT、超声心动图在小儿川崎病冠状动脉病变患者心功能评估中的价值对比[J]. 中国CT和MRI杂志, 2022, 20(1):85-87.
[8] 曹静, 梁豪, 王兵. 超声心动图联合ANCA、Cys-C在川崎病冠状动脉病变早期诊断中的价值研究[J]. 中国疗养医学, 2022, 31(9):990-993.
[9] 刘文芹, 夏焙, 范舒旻, 等. 川崎病冠状动脉瘤的2种超声心动图诊断方法分析[J]. 中华儿科杂志, 2022, 60(6):588-593.
[10] 陈强, 赵海燕, 訾慧芬, 等. 心型脂肪酸结合蛋白及冠状动脉Z值在川崎病早期诊断的临床意义[J]. 中国中西医结合儿科学, 2021, 13(1):58-62.
[11] 舒国琴. 大剂量丙种球蛋白治疗川崎病患儿的疗效及对冠状动脉异常情况的影响分析[J]. 黑龙江医学, 2022, 46(5):532-534.
[12] 黄铮, 吴平生. 美国心脏病学会(AHA)川崎病诊断指南[J]. 岭南心血管病杂志, 2003, 9(4):301.
[13] 高明东, 王建军, 缪树琼, 等. Z值对儿童川崎病冠状动脉病变的评估价值[J]. 中国小儿急救医学, 2018, 25(6):442-445, 449.
[14] 陈晶晶, 刘亚黎. Kobayashi评分体系在中国川崎病患儿中的临床应用价值[J]. 华中科技大学学报(医学版), 2011, 40(6):746-749.
[15] Zhou Z Q, Wen L Y, Fu C, et al. Association of left ventricular systolic dysfunction with coronary artery dilation in Kawasaki disease patients:Assessment with cardiovascular magnetic resonance[J]. European Journal of Radiology, 2021, 145(8):e110039.
[16] Wang L X, Yang Y N, Cui Q M, et al. Evaluating the added predictive ability of MMP-9 in serum for Kawasaki disease with coronary artery lesions[J]. Journal of Investigative Medicine:the Official Publication of the American Federation for Clinical Research, 2021, 69(1):13-19.
[17] 张英谦, 王华, 李亚楠, 等. 川崎病患儿冠状动脉病变的临床特征及其风险预测指标评价[J]. 中国医药, 2020, 15(12):1831-1835.
[18] 卢小琼, 单光颂, 王本臻, 等. 经胸超声心动图和螺旋CT冠状动脉成像在川崎病冠状动脉病变随访中应用价值的比较[J]. 中国实用儿科杂志, 2021, 36(5):382-386, 397.
[19] 王复娟, 吴良霞. 川崎病冠状动脉损害相关危险因素分析[J]. 临床儿科杂志, 2020, 38(7):481-484.
[20] 刘刚, 李星妍, 祝伟宏, 等. 超声心动图冠状动脉内径Z值定量评估川崎病患儿冠状动脉病变的严重程度及预测预后的临床价值[J]. 临床合理用药杂志, 2020, 13(36):159-161.