Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China.
Eur J Clin Invest. 2021 Mar;51(3):e13409. doi: 10.1111/eci.13409. Epub 2020 Sep 25.
Accurate classification of coronary artery abnormalities (CAAs) is essential for clinical decision-making and long-term management in Kawasaki disease (KD) patients. To date, there are several echocardiographic criteria of CAA assessment.
The Japanese Ministry of Health (JMH) criteria and the Z-score criteria from 2004 American Heart Association guidelines were adopted and their detective efficacies for CAAs were compared in 251 Chinese patients with KD Z scores were calculated by 6 published methods.
According to the JMH criteria, 19 (7.57%) KD patients were classified as CAAs during the acute KD episode. However, the detective number of CAAs was highest and had a 0.68-fold increase by the Dallaire et al method with a Z-score cut point of ≥2.5 as compared with the JMH criteria; in contrast, more than 78.95% of patients with CAAs identified by the JMH criteria had a coronary artery Z score ≥2.5. All 6 different Z-score methods had satisfactory accuracies with a range from 93.23% to 97.61% in screening CAAs. For the 19 patients with CAAs identified by the JMH criteria, their Z scores presented the widest variation calculated by the McCrindle et al method.
The JMH criteria underestimate the prevalence of CAAs as compared with the Z-score criteria. Quantitative assessment of coronary artery luminal dimensions, normalized as Z scores adjusted for body surface, should be recommended. The larger coronary artery luminal dimensions vary, the more heterogeneous Z scores calculated by different methods have.
准确分类冠状动脉异常（CAA）对于川崎病（KD）患者的临床决策和长期管理至关重要。迄今为止，已经有几种超声心动图 CAA 评估标准。
采用日本厚生劳动省（JMH）标准和 2004 年美国心脏协会指南的 Z 评分标准，并比较了这两种标准对 251 例中国 KD 患者 CAA 的检出效能。采用 6 种已发表的方法计算 Z 评分。
根据 JMH 标准，19 例（7.57%）KD 患者在急性期 KD 中被归类为 CAA。然而，通过 Dallaire 等人的方法，Z 评分切点≥2.5 时，CAA 的检出数量最高，检出率增加了 0.68 倍；相比之下，JMH 标准确定的 CAA 患者中，超过 78.95%的患者冠状动脉 Z 评分≥2.5。所有 6 种不同的 Z 评分方法在筛查 CAA 方面均具有较高的准确性，范围为 93.23%至 97.61%。对于 JMH 标准确定的 19 例 CAA 患者，其 Z 评分采用 McCrindle 等人的方法计算时，变化最大。
与 Z 评分标准相比，JMH 标准低估了 CAA 的患病率。应推荐定量评估冠状动脉管腔尺寸，通过体表面积进行 Z 评分校正。不同方法计算的冠状动脉管腔尺寸变化越大，Z 评分的异质性越大。
