【摘要】 目的:分析超声心动图冠状动脉Z值在川崎病(KD)患儿治疗前后的变化及其预测因素。方法:收集确诊并住院治疗后复查的KD患儿215例，采用超声心动图检查测量左冠状动脉主干(LMCA)、左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)近段(RCA-P)、RCA中段(RCA-M)、RCA远段(RCA-D)内径，计算不同分支内径的Z值，取最大Z值作为该患儿的Z值评价依据。患儿均接受静脉注射人丙种球蛋白(IVIG)和阿司匹林口服治疗。根据治疗前后的Z值差值(ΔZ值)将患儿分为消退组(治疗后6个月Z值较治疗前下降≥1,107例)、稳定组(治疗后6个月Z值波动幅度<1,75例)和进展组(治疗后6个月Z值较治疗前上升≥1,33例)。比较各组患儿一般资料[性别、年龄、身高、体重、体表面积(BSA)、心率、发热时间],检测患儿治疗前及治疗后6个月的生化指标[血小板(PLT)、C-反应蛋白(CRP)、白细胞(WBC)、血沉(ESR)、红细胞(RBC)、中性粒细胞百分比(NE%)、白蛋白(ALB)、血红蛋白(HGB)]水平。分析患儿治疗前后生化指标差值与ΔZ值的相关性，并进行多元线性回归分析，筛选出影响ΔZ值的独立危险因素。结果:与治疗前比较，消退组和稳定组患儿治疗后6个月心率、PLT、CRP、WBC、ESR和NE%水平降低，RBC、ALB和HGB水平升高(均P<0.05);进展组患儿治疗后6个月心率、PLT、CRP、WBC、ESR和NE%水平升高，RBC、ALB和HGB水平降低(均P<0.05)。ΔZ值与治疗前心率、PLT、CRP、WBC、ESR和NE%水平呈正相关，与ALB水平呈负相关(均P<0.05)。多元线性回归分析结果表明，治疗前CRP对ΔZ值具有显著影响(P<0.05)。ΔZ值与Δ心率、ΔPLT、ΔCRP、ΔWBC、ΔESR和ΔNE%水平呈正相关，与ΔRBC、ΔALB和ΔHGB水平呈负相关(均P<0.05)。多元线性回归分析结果表明，Δ心率、ΔWBC、ΔRBC和ΔNE%对ΔZ值具有显著影响(均P<0.05)。结论:基于治疗前后的Z值差值评估预后，治疗前CRP对川崎病患儿预后具有预测价值。治疗前后的心率、WBC、RBC和NE%差值是KD患儿预后的独立预测因素。更多还原

【Abstract】 Objective:To analyze the changes in echocardiographic coronary artery Z-scores before and after treatment in children with Kawasaki disease(KD) and identify associated predictive factors.Methods:A total of 215 KD children who were diagnosed and hospitalized for treatment and then re-examined were collected.Echocardiography was used to measure the internal diameters of left main coronary artery(LMCA),left anterior descending artery(LAD),left circumflex artery(LCX),proximal segment of the right coronary artery(RCA-P),middle segment of the right coronary artery(RCA-M),and distal segment of the right coronary artery(RCA-D),and Z-scores for each segment were calculated, and the maximum Z-score was used as the evaluation index for each children.All children received intravenous immunoglobulin(IVIG) and oral aspirin.Based on the difference in Z-scores before and after treatment(ΔZ-score),the children were divided into the regression group(Z-score at 6 months after treatment decreased by ≥1 compared with that before treatment, 107 cases),stable group(fluctuation range of Z-score at 6 months after treatment was <1,75 cases),and progression group(Z-score at 6 months after treatment increased by ≥1 compared with that before treatment, 33 cases).Gender, age, height, weight, body surface area(BSA),heart rate, fever duration, platelets(PLT),C-reactive protein(CRP),white blood cells(WBC),erythrocyte sedimentation rate(ESR),red blood cells(RBC),neutrophil percentage(NE%),albumin(ALB),hemoglobin(HGB) before treatment and at 6 months after treatment were compared.The correlation between the difference of biochemical indicators before and after the treatment and ΔZ-score of the KD children was analyzed, and multiple linear regression analysis was conducted to screen out the independent risk factors affecting the ΔZ-score.Results:Compared with those before treatment, the levels of heart rate, PLT,CRP,WBC,ESR,and NE% at 6 months after treatment in the regression group and stable group decreased, while the levels of RBC,ALB,and HGB increased(all P<0.05);the levels of heart rate, PLT,CRP,WBC,ESR,and NE% at 6 months after treatment in the progression group increased, while the levels of RBC,ALB,and HGB decreased(all P<0.05).The ΔZ-score was significantly positively correlated with the levels of heart rate, PLT,CRP,WBC,ESR,and NE% before treatment, and significantly negatively correlated with the level of ALB before treatment(all P<0.05).The results of multiple linear regression analysis indicated that pre-treatment CRP had a significant effect on the ΔZ-score(P<0.05).ΔZ-score was positively correlated with Δheart rate, ΔPLT,ΔCRP,ΔWBC,ΔESR,and ΔNE%,and negatively correlated with ΔRBC,ΔALB,and ΔHGB(all P<0.05).Multiple linear regression indicated that Δheart rate, ΔWBC,ΔRBC,and ΔNE% as independent predictors of ΔZ-score(all P<0.05).Conclusion:Evaluating prognosis based on ΔZ before and after treatment, pre-treatment CRP has predictive value for Kawasaki disease outcomes.Differences in heart rate, WBC,RBC,and NE% before and after treatment are independent predictors of prognosis in KD children.更多还原