Liu W Q, Xia B, Fan W, Yu Z, Lin W L, Chen L, Wang C, Liu B N, Li J, Yang Jun
Department of Ultrasonography, Shenzhen Children's Hospital, Shenzhen 518038, China.
Department of Cardiovascular Medicine, Shenzhen Children's Hospital, Shenzhen 518038, China.
Zhonghua Er Ke Za Zhi. 2022 Jun 2;60(6):588-593. doi: 10.3760/cma.j.cn112140-20220316-00205.
To analyze the difference between Z score and previous criteria in the diagnosis characteristics of coronary artery aneurysm (CAA) in Kawasaki disease, and to investigate the clinical distribution of Kawasaki disease CAA in the Z score group. This study retrospectively analyzed the clinical and echocardiographic data of 2 419 children with Kawasaki disease in Shenzhen Children's Hospital from January 2009 to December 2019. The traditional criteria and Z score criteria were used to diagnose CAA, and the differences of diagnostic efficiency between the 2 diagnostic methods were analyzed. The clinical distribution characteristics of CAA in children with Kawasaki disease were analyzed by grouping their sex, clinical classification (complete Kawasaki disease, incomplete Kawasaki disease) the sensitivity to intravenous immunoglobulin (IVIG) (IVIG-sensitive Kawasaki disease,IVIG-unresponsive Kawasaki disease). And the course of the disease (≤6 weeks, >6-8 weeks, >8 weeks to 6 months) etc. The χ² test or Kruskal-Wallis test was used for comparison between the groups, and the Kappa test was used for consistency evaluation. Among the 2 419 children with Kawasaki disease, 1 558 were males and 861 were females. The age of onset was 1.8 (1.0, 3.2) years. The rate of CAA by Z score criteria was higher than that by traditional method (21.9% (529/2 419) 13.9% (336/2 419), χ=1 074.94, 0.001). Compared to the traditional method, the Z score criteria found higher rate of CAA in male patients, patients with incomplete Kawasaki disease, and IVIG-unresponsive patients (25.2% (392/1 558) 16.0% (249/1 558), (32.7% (166/507) 19.5% (99/507), 30.5% (95/312) 24.0% (75/312), χ=694.05, 216.19, 184.37, all 0.001). The Z score criteria was consistent with the traditional method in diagnosing CAA (κ=0.642,<0.001). Moreover, in the Z score criteria, the rate of CAA in males (25.2%, 392/1 558) was higher than that in females (15.9%, 137/861), higher in incomplete Kawasaki cases (32.7%, 166/507) than that in complete Kawasaki case (19.0%, 363/1 912), and higher in IVIG-unresponsive cases (30.4%, 95/312) than that in IVIG-sensitive cases (20.6%, 434/2 107), with statistically significant differences (χ=27.76, 44.38, 15.43, all <0.001). Coronary Z score of course ≤ 6 weeks was greater than that of course between>6-8 weeks and >8 weeks to 6 months (1.3 (0.7, 2.3) 0.7 (0.3, 1.4), 0.7 (0.3, 1.3), 20.65, 13.70, both 0.001). The rate of CAA in Kawasaki disease by Z score criteria is higher than that by traditional method. In the Z score group, most CAA occur within 6 weeks of the course of the disease, and the rate of CAA in male, incomplete Kawasaki disease, and IVIG-unresponsive is higher.
分析Z评分与既往标准在川崎病冠状动脉瘤（CAA）诊断特征上的差异，并探讨Z评分组川崎病CAA的临床分布情况。本研究回顾性分析了2009年1月至2019年12月在深圳儿童医院就诊的2419例川崎病患儿的临床和超声心动图资料。采用传统标准和Z评分标准诊断CAA，分析两种诊断方法诊断效率的差异。通过对川崎病患儿的性别、临床分型（完全性川崎病、不完全性川崎病）、对静脉注射免疫球蛋白（IVIG）的敏感性（IVIG敏感型川崎病、IVIG无反应型川崎病）以及病程（≤6周、>6 - 8周、>8周至6个月）等进行分组，分析川崎病CAA的临床分布特征。组间比较采用χ²检验或Kruskal - Wallis检验，一致性评价采用Kappa检验。在2419例川崎病患儿中，男性1558例，女性861例。发病年龄为1.8（1.0，3.2）岁。Z评分标准诊断CAA的发生率高于传统方法（21.9%（529/2419）对13.9%（336/2419），χ = 1074.94，P < 0.001）。与传统方法相比，Z评分标准在男性患者、不完全性川崎病患者和IVIG无反应患者中发现CAA的发生率更高（25.2%（392/1558）对16.0%（249/1558），（32.7%（166/507）对19.5%（99/507），30.5%（95/312）对24.0%（75/312），χ = 694.05，216.19，184.37，P均 < 0.001）。Z评分标准与传统方法在诊断CAA方面具有一致性（κ = 0.642，P < 0.001）。此外，在Z评分标准中，男性CAA发生率（25.2%，392/1558）高于女性（15.9%，137/861），不完全性川崎病病例（32.7%，166/507）高于完全性川崎病病例（19.0%，363/1912），IVIG无反应病例（30.4%，95/312）高于IVIG敏感病例（20.6%，434/2107），差异均有统计学意义（χ = 27.76，44.38，15.43，P均 < 0.001）。病程≤6周的冠状动脉Z评分大于病程在>6 - 8周和>8周至6个月之间的（1.3（0.7，2.3）对0.7（0.3，1.4），0.7（0.3，1.3），χ = 20.65，13.70，P均 < 0.001）。Z评分标准诊断川崎病CAA的发生率高于传统方法。在Z评分组中，大多数CAA发生在病程6周内，男性、不完全性川崎病和IVIG无反应者CAA发生率更高。
