超声心动图定量评价川崎病患儿7~14年冠状动脉Z值变化

目的 应用超声心动图Z值评价川崎病（KD）患儿7~14年后冠状动脉（简称冠脉）Z值变化。方法 回顾性分析100例7~14年恢复期KD患儿的超声心动图，包括急性期呈冠脉扩张54例（扩张组）、无扩张46例（无扩张组），另取同期健康儿童51名作为对照组，比较左冠脉主干（LMCA）、左前降支（LAD）和右冠脉近段（pRCA）内径及其Z值变化，分析恢复期冠脉内径变化的影响因素。结果 扩张组冠脉内径大于无扩张组和对照组（P均< 0.05），而后二者冠脉内径差异无统计学意义（P均> 0.05）。扩张组LMCA、LAD和pRCA的Z值分别为0.569 5±1.061 6、0.420（-0.029，1.078）和0.640（0.283，1.250），无扩张组LMCA、LAD和pRCA的Z值分别为-0.031 3±0.846 7、-0.066 2±0.661 2和0.188 7±0.593 5，对照组LMCA、LAD和pRCA的Z值分别为-0.124 6±1.016 7、-0.255 8±1.084 8和0.194 3±0.610 1，扩张组冠脉Z值大于无扩张组和对照组（P均< 0.05），后二者Z值差异无统计学意义（P>0.05）。急性期冠脉扩张程度是KD冠脉持续扩张的影响因子（诊断优势比=39.146，P<0.001）。结论 恢复期7~14年，KD急性期冠脉扩张患者冠脉内径及Z值仍增大。KD急性期冠脉损伤程度是远期冠脉变化的影响因素。

Echocardiographic assessment of coronary artery Z scores in children with Kawasaki disease after 7-14 years

Objective To assess long-term outcomes of coronary artery (CA) Z scores in children with Kawasaki disease (KD) with echocardiography. Methods Echocardiographic data of 100 KD children during 7-14 years interval follow-up were analyzed retrospectively. The children were divided into dilatation group (n=54, CA dilated) and non-dilatation group (n=46, CA not dilated) at the acute phase. Fifty-one children were selected simultaneously as the controls (control group). Diameters and Z scores of left main coronary artery (LMCA), left anterior descending (LAD) and proximal right coronary artery (pRCA) were compared, and factors affecting CA diameter during the recovery phase were analyzed. Results CA diameters in dilatation group were larger than those in non-dilatation group and control group (all P<0.05), whereas no statistical difference of CA diameter was found between non-dilatation group and control group (all P>0.05). In dilatation group, Z score of LMCA, LAD and pRCA was 0.569 5±1.061 6, 0.420(-0.029,1.078) and 0.640 (0.283, 1.250), while in non-dilatation group, Z score of LMCA, LAD and pRCA was -0.031 3±0.846 7, -0.066 2±0.661 2 and 0.188 7±0.593 5, respectively. In control group, Z score of LMCA, LAD and pRCA was -0.124 6±1.016 7, -0.255 8±1.084 8 and 0.194 3±0.610 1, respectively. Z scores in dilatation group were larger than those in non-dilatation group and control group (all P<0.05), while no statistical differences of Z scores was found between non-dilatation group and control group (all P>0.05). Dilation degree of CA at the acute phase was the factor affecting long-term CA dilation (odds ratio=39.146, P<0.001). Conclusion During 7-14 years of follow-up, CA diameters and Z scores kept to increase in KD children with CA dilatation at the acute phase. The dilation degree of CA at the acute phase in KD children affects the long-term CA dilation.