Department of Pediatrics, NTT Sapporo Medical Center.
Circ J. 2017 Dec 25;82(1):247-250. doi: 10.1253/circj.CJ-17-0046. Epub 2017 Aug 25.
In the present study we used echocardiography to investigate coronary artery diameter at the time of diagnosis of Kawasaki disease (KD), before the start of treatment.Methods and Results:Diameters of the right, left main, left anterior descending, and left circumflex coronary arteries were determined in 410 patients before KD treatment commenced. The maximum Z-score was considered to be the pretreatment, maximum coronary artery Z-score (preZmax). The cumulative probability of coronary arterial dilatation was analyzed using the Kaplan-Meier method. In the present study, 31 patients (7.6%) had a preZmax ≥3.0, 56 (13.7%) had a preZmax ≥2.5, and 96 (23.4%) had a preZmax ≥2.0. The cumulative probability of a preZmax ≥2.0 was >20% on Day 5 of illness, 40% on Day 7, and 70% on Day 10. The positive predictive value (PPV) of a preZmax of 2.0 was approximately 0.9 on Day 5 of illness.
The present study demonstrates that the coronary arteries may dilate before Day 5 of illness, and that the rate of dilatation increases gradually until Day 10. Because preZmax 2.0 has high PPV after Day 5 of illness, it is a useful marker of coronary artery dilatation in the early phase of KD.
在本研究中，我们使用超声心动图在川崎病（KD）诊断时，即在开始治疗之前，来研究冠状动脉的直径。
在 KD 治疗开始前，我们对 410 例患者的右冠状动脉、左主干、左前降支和左旋支的直径进行了测定。最大 Z 评分被认为是预处理的最大冠状动脉 Z 评分（preZmax）。采用 Kaplan-Meier 方法分析冠状动脉扩张的累积概率。在本研究中，31 例（7.6%）患者的 preZmax≥3.0，56 例（13.7%）患者的 preZmax≥2.5，96 例（23.4%）患者的 preZmax≥2.0。在发病第 5 天，preZmax≥2.0 的累积概率>20%，第 7 天为 40%，第 10 天为 70%。在发病第 5 天，preZmax 为 2.0 的阳性预测值（PPV）约为 0.9。
本研究表明，冠状动脉可能在发病第 5 天之前扩张，扩张速度逐渐增加，直至第 10 天。由于发病后第 5 天的 preZmax 2.0 具有较高的 PPV，因此它是 KD 早期冠状动脉扩张的有用标志物。
