Department of Cardiology at Children's Hospital Boston, Boston, MA; and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Circ Cardiovasc Imaging. 2013 Mar 1;6(2):239-44. doi: 10.1161/CIRCIMAGING.112.000159. Epub 2013 Jan 28.
Coronary artery (CA) dilatation on echocardiography is a criterion for treatment with intravenous immunoglobulin for incomplete Kawasaki disease (KD). However, CA dimensions for febrile children are unknown. We compared CA dimensions in children with febrile illnesses other than KD to those of normal afebrile children and to KD patients.
We performed echocardiograms in 43 patients who met the following inclusion criteria: (1) age 3 months to 18 years, (2) daily fever >38°C for ≥96 hours, and (3) a diagnosis other than KD. These subjects had mean CA z scores greater than normative values (left main CA=0.66±0.75, P<0.001; right CA=0.28±0.81, P=0.03; left anterior descending CA=0.35±1.0, P=0.03). Maximum CA z score >2 was found in 2 subjects (osteomyelitis, Mycoplasma pneumonia). Among demographic and laboratory measures, only higher platelet count was associated with greater left anterior descending CA z scores (P=0.004) and maximum CA z score (P=0.03). Non-KD febrile subjects, compared with 144 KD patients, had smaller CA z scores (P=0.04, P<0.001, and P<0.001 for left main CA, right CA, and left anterior descending CA, respectively), and lower white blood cell count, erythrocyte sedimentation rate, and platelet count (all P<0.001). A maximum CA z score cutoff of 2.0 had specificity of 95% (95% confidence interval, 84%-99%) and sensitivity of 32% (95% confidence interval, 25%-41%) in distinguishing non-KD febrile from KD patients; for maximum CA z score of 2.5, specificity was 98% and sensitivity was 20%.
This pilot study found that mean CA dimensions in children with non-KD febrile illnesses are larger than those in normative afebrile subjects but smaller than dimensions in patients with KD. Future studies should augment the available data on CA dimensions in children with more severe febrile illnesses.
超声心动图显示冠状动脉扩张是川崎病（KD）患儿静脉注射免疫球蛋白治疗的一个标准。然而，对于发热患儿的冠状动脉尺寸尚不清楚。我们比较了发热但非 KD 患儿的冠状动脉尺寸与正常无热患儿和 KD 患儿的冠状动脉尺寸。
我们对符合以下纳入标准的 43 名患者进行了超声心动图检查：（1）年龄 3 个月至 18 岁，（2）每日发热>38°C 持续 96 小时以上，（3）诊断为非 KD。这些患者的平均冠状动脉 z 评分大于正常值（左主干冠状动脉=0.66±0.75，P<0.001；右冠状动脉=0.28±0.81，P=0.03；左前降支冠状动脉=0.35±1.0，P=0.03）。2 例患者（骨髓炎、肺炎支原体）最大冠状动脉 z 评分>2。在人口统计学和实验室指标中，只有较高的血小板计数与较大的左前降支冠状动脉 z 评分（P=0.004）和最大冠状动脉 z 评分（P=0.03）相关。与 144 例 KD 患者相比，非 KD 发热患者的冠状动脉 z 评分更小（P=0.04，P<0.001 和 P<0.001 分别为左主干冠状动脉、右冠状动脉和左前降支冠状动脉），白细胞计数、红细胞沉降率和血小板计数均较低（均 P<0.001）。最大冠状动脉 z 评分的截断值为 2.0 时，非 KD 发热与 KD 患者的特异性为 95%（95%置信区间，84%-99%），敏感性为 32%（95%置信区间，25%-41%）；最大冠状动脉 z 评分 2.5 时，特异性为 98%，敏感性为 20%。
本研究发现，非 KD 发热患儿的平均冠状动脉尺寸大于正常无热患儿，但小于 KD 患儿的冠状动脉尺寸。未来的研究应增加对更严重发热疾病患儿的冠状动脉尺寸的现有数据。
