一种使用Lambda-Mu-Sigma方法得出的小儿冠状动脉内径新Z评分曲线
A New Z Score Curve of the Coronary Arterial Internal Diameter Using the Lambda-Mu-Sigma Method in a Pediatric Population.
作者信息
Kobayashi Tohru, Fuse Shigeto, Sakamoto Naoko, Mikami Masashi, Ogawa Shunichi, Hamaoka Kenji, Arakaki Yoshio, Nakamura Tsuneyuki, Nagasawa Hiroyuki, Kato Taichi, Jibiki Toshiaki, Iwashima Satoru, Yamakawa Masaru, Ohkubo Takashi, Shimoyama Shinya, Aso Kentaro, Sato Seiichi, Saji Tsutomu
机构信息
Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan.
Department of Pediatrics, NTT East Japan Sapporo Hospital, Sapporo, Japan.
出版信息
J Am Soc Echocardiogr. 2016 Aug;29(8):794-801.e29. doi: 10.1016/j.echo.2016.03.017. Epub 2016 Jun 7.
BACKGROUND
Several coronary artery Z score models have been developed. However, a Z score model derived by the lambda-mu-sigma (LMS) method has not been established.
METHODS
Echocardiographic measurements of the proximal right coronary artery, left main coronary artery, proximal left anterior descending coronary artery, and proximal left circumflex artery were prospectively collected in 3,851 healthy children ≤18 years of age and divided into developmental and validation data sets. In the developmental data set, smooth curves were fitted for each coronary artery using linear, logarithmic, square-root, and LMS methods for both sexes. The relative goodness of fit of these models was compared using the Bayesian information criterion. The best-fitting model was tested for reproducibility using the validation data set. The goodness of fit of the selected model was visually compared with that of the previously reported regression models using a Q-Q plot.
RESULTS
Because the internal diameter of each coronary artery was not similar between sexes, sex-specific Z score models were developed. The LMS model with body surface area as the independent variable showed the best goodness of fit; therefore, the internal diameter of each coronary artery was transformed into a sex-specific Z score on the basis of body surface area using the LMS method. In the validation data set, a Q-Q plot of each model indicated that the distribution of Z scores in the LMS models was closer to the normal distribution compared with previously reported regression models. Finally, the final models for each coronary artery in both sexes were developed using the developmental and validation data sets. A Microsoft Excel-based Z score calculator was also created, which is freely available online (http://raise.umin.jp/zsp/calculator/).
CONCLUSIONS
Novel LMS models with which to estimate the sex-specific Z score of each internal coronary artery diameter were generated and validated using a large pediatric population.
背景
已经开发了几种冠状动脉Z评分模型。然而，尚未建立通过lambda-mu-sigma（LMS）方法得出的Z评分模型。
方法
前瞻性收集了3851名18岁及以下健康儿童的右冠状动脉近端、左冠状动脉主干、左前降支冠状动脉近端和左旋支冠状动脉近端的超声心动图测量数据，并分为发育数据集和验证数据集。在发育数据集中，使用线性、对数、平方根和LMS方法对两性的每条冠状动脉拟合平滑曲线。使用贝叶斯信息准则比较这些模型的相对拟合优度。使用验证数据集测试最佳拟合模型的可重复性。使用Q-Q图将所选模型的拟合优度与先前报道的回归模型进行直观比较。
结果
由于两性之间每条冠状动脉的内径不相似，因此开发了针对性别的Z评分模型。以体表面积为自变量的LMS模型显示出最佳的拟合优度；因此，使用LMS方法根据体表面积将每条冠状动脉的内径转换为性别特异性Z评分。在验证数据集中，每个模型的Q-Q图表明，与先前报道的回归模型相比，LMS模型中Z评分的分布更接近正态分布。最后，使用发育数据集和验证数据集开发了两性中每条冠状动脉的最终模型。还创建了一个基于Microsoft Excel的Z评分计算器，可在网上免费获取（http://raise.umin.jp/zsp/calculator/）。
结论
使用大量儿科人群生成并验证了用于估计每条冠状动脉内径性别特异性Z评分的新型LMS模型。
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