中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2014年
7期
531-536
,共6页
范舒旻%夏焙%陈伟玲%刘晓%许娜%于红奎%林洲%欧福祥%吴姗%曾德俊%黄兵旋
範舒旻%夏焙%陳偉玲%劉曉%許娜%于紅奎%林洲%歐福祥%吳姍%曾德俊%黃兵鏇
범서민%하배%진위령%류효%허나%우홍규%림주%구복상%오산%증덕준%황병선
超声心动描记术%黏膜皮肤淋巴结综合征%Z值%儿童
超聲心動描記術%黏膜皮膚淋巴結綜閤徵%Z值%兒童
초성심동묘기술%점막피부림파결종합정%Z치%인동
Echocardiography%Mucocutaneous lymph node syndrome%Z-score%Child
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 vs 20.4±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。
目的：探討超聲心動圖冠狀動脈內徑Z值定量川崎病（KD）冠狀動脈病變的臨床意義。方法迴顧分析612例KD患兒急性期超聲心動圖冠狀動脈內徑及其臨床錶現。將冠狀動脈內徑轉換為Z值，KD患兒按冠狀動脈Z值的大小分為4組，無擴張組（ND）415例、小冠狀動脈瘤組（SCAAs）133例、大冠狀動脈瘤組（LCAAs）47例及巨大冠狀動脈瘤組（GCAAs）17例，比較各組患兒間性彆、年齡、典型病例比例、髮熱時間、實驗室檢查結果（C-反應蛋白、紅細胞沉降率、白細胞、血小闆），以及恢複期冠狀動脈內徑及其Z值變化。結果 ND組KD患兒髮熱天數為（7.75±3.12）d、SCAAs組為（8.50±4.12）d、LCAAs組為（8.57±3.58）d、GCAAs組為（11.88±4.33）d，各組KD患兒髮熱天數隨冠狀動脈Z值的增大有逐漸延長的趨勢（F=22.375，P＜0.05）。各組KD患兒C-反應蛋白、紅細胞沉降率及白細胞比較，差異均無統計學意義（F=0.236、1.116、0.121，P均＞0.05）；但各組KD患兒血小闆數量間差異有統計學意義，血小闆數量隨冠狀動脈Z值增大有逐漸增多的趨勢，以GCAAs組患兒的血小闆數量最高（F=22.029，P=0.000）。與急性期比較，ND組的患兒在恢複期冠脈內徑的差異無統計學意義[（2.24±0.34）mm vs（2.33±0.36）mm，t=1.926，P＞0.05]，但其Z值的比較（0.41±0.82 vs 1.17±0.75）結果顯示差異有統計學意義（t=8.332，P＜0.05）；併且SCAAs組（1.32±0.89 vs 3.40±0.62）、LCAAs組（3.12±2.27 vs 6.20±1.28）、GCAAs組（11.88±6.77 vs 20.4±9.70）冠狀動脈內徑Z值均比急性期減小，差異均有統計學意義（t=11.073、4.579、3.480， P均＜0.05）。結論冠狀動脈內徑Z值是經體錶麵積校正的標準值，消除瞭病程中患兒年齡增長的因素，可準確反映KD冠狀動脈病變的嚴重程度及其恢複期變化過程。根據患兒的年齡和身體大小準確定量冠狀動脈內徑對KD管理及評估預後具有重要意義。
목적：탐토초성심동도관상동맥내경Z치정량천기병（KD）관상동맥병변적림상의의。방법회고분석612례KD환인급성기초성심동도관상동맥내경급기림상표현。장관상동맥내경전환위Z치，KD환인안관상동맥Z치적대소분위4조，무확장조（ND）415례、소관상동맥류조（SCAAs）133례、대관상동맥류조（LCAAs）47례급거대관상동맥류조（GCAAs）17례，비교각조환인간성별、년령、전형병례비례、발열시간、실험실검사결과（C-반응단백、홍세포침강솔、백세포、혈소판），이급회복기관상동맥내경급기Z치변화。결과 ND조KD환인발열천수위（7.75±3.12）d、SCAAs조위（8.50±4.12）d、LCAAs조위（8.57±3.58）d、GCAAs조위（11.88±4.33）d，각조KD환인발열천수수관상동맥Z치적증대유축점연장적추세（F=22.375，P＜0.05）。각조KD환인C-반응단백、홍세포침강솔급백세포비교，차이균무통계학의의（F=0.236、1.116、0.121，P균＞0.05）；단각조KD환인혈소판수량간차이유통계학의의，혈소판수량수관상동맥Z치증대유축점증다적추세，이GCAAs조환인적혈소판수량최고（F=22.029，P=0.000）。여급성기비교，ND조적환인재회복기관맥내경적차이무통계학의의[（2.24±0.34）mm vs（2.33±0.36）mm，t=1.926，P＞0.05]，단기Z치적비교（0.41±0.82 vs 1.17±0.75）결과현시차이유통계학의의（t=8.332，P＜0.05）；병차SCAAs조（1.32±0.89 vs 3.40±0.62）、LCAAs조（3.12±2.27 vs 6.20±1.28）、GCAAs조（11.88±6.77 vs 20.4±9.70）관상동맥내경Z치균비급성기감소，차이균유통계학의의（t=11.073、4.579、3.480， P균＜0.05）。결론관상동맥내경Z치시경체표면적교정적표준치，소제료병정중환인년령증장적인소，가준학반영KD관상동맥병변적엄중정도급기회복기변화과정。근거환인적년령화신체대소준학정량관상동맥내경대KD관리급평고예후구유중요의의。
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>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 > 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.
