根据既定指南和 Z 评分公式诊断川崎病患者的冠状动脉异常。
Diagnosis of Coronary Artery Abnormalities in Patients with Kawasaki Disease According to Established Guidelines and Z Score Formulas.
机构信息
Department of Pediatrics, CHA Bundang Medical Center, CHA University, Gyeonggido, South Korea.
Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, South Korea.
出版信息
J Am Soc Echocardiogr. 2021 Jun;34(6):662-672.e3. doi: 10.1016/j.echo.2021.01.002. Epub 2021 Jan 7.
BACKGROUND
The diagnosis of coronary artery abnormalities (CAA), including dilation and aneurysm, in patients with Kawasaki disease is paramount to treatment planning. CAA are defined using various standards, which makes diagnosis difficult. The aims of this study were to determine the variability of CAA prevalence according to existing guidelines and Z score formulas and to examine the discrepancies in widely used Z score formulas.
METHODS
Using data from a Korean national survey on Kawasaki disease, 6,889 patients were included and analyzed. The overall prevalence of CAA and the prevalence for subgroups were compared on the basis of aneurysm severity, age, and body surface area. Finally, discrepancies among five Z score formulas were evaluated by comparing two of the formulas in pairs.
RESULTS
According to the Japanese criteria, the prevalence of CAA was 18%. According to the American Heart Association criteria, the prevalence of dilation or aneurysm was about 21% to 42%, and that of aneurysm of the left anterior descending artery or right coronary artery was about 8% to 27%. The prevalence of CAA and that of left anterior descending or right coronary artery aneurysm was significantly different, with discrepancies between the Japanese and AHA Z score criteria, as well as among the five Z score formulas. Additionally, misclassification of aneurysm severity was observed for each criterion or Z score formula. There was significant variation among calculated Z scores. The more extreme the Z score values, the more discrepancy was observed.
CONCLUSIONS
Different guidelines and Z score formulas yield significantly different prevalence rates and classifications of CAA. In addition, more discrepancies were observed with higher Z score values. As CAA or aneurysm severity could be changed by guidelines or Z score formulas, they should be chosen carefully, and when a particular formula is chosen, consistency is needed.
背景
川崎病患者冠状动脉异常（CAA）的诊断，包括扩张和动脉瘤，对治疗计划至关重要。CAA 使用各种标准定义，这使得诊断变得困难。本研究旨在根据现有的指南和 Z 分数公式确定 CAA 患病率的可变性，并检查广泛使用的 Z 分数公式之间的差异。
方法
使用韩国川崎病全国调查的数据，纳入并分析了 6889 例患者。根据动脉瘤严重程度、年龄和体表面积，比较了总体 CAA 患病率和亚组患病率。最后，通过比较两种公式对 5 种 Z 分数公式之间的差异进行了评估。
结果
根据日本标准，CAA 的患病率为 18%。根据美国心脏协会标准，扩张或动脉瘤的患病率约为 21%至 42%，左前降支或右冠状动脉动脉瘤的患病率约为 8%至 27%。CAA 和左前降支或右冠状动脉动脉瘤的患病率有显著差异，日本和 AHA Z 分数标准之间以及 5 种 Z 分数公式之间存在差异。此外，每个标准或 Z 分数公式均存在动脉瘤严重程度的分类错误。计算的 Z 分数存在显著差异。Z 分数值越极端，差异越大。
结论
不同的指南和 Z 分数公式产生的 CAA 患病率和分类有显著差异。此外，Z 分数越高，观察到的差异越大。由于 CAA 或动脉瘤严重程度可能因指南或 Z 分数公式而改变，因此应谨慎选择，并在选择特定公式时需要保持一致性。
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