[1]严晓华,张泰鸣,高娜,等.超声心动图冠状动脉Z值在川崎病患儿治疗前后的变化及其预测因素分析[J].陕西医学杂志,2025,54(12):1641-1649.[doi:DOI:10.3969/j.issn.1000-7377.2025.12.009]
　YAN Xiaohua,ZHANG Taiming,GAO Na,et al.Changes in echocardiographic coronary artery Z-scores before and after treatment in children with Kawasaki disease and its predictors[J].,2025,54(12):1641-1649.[doi:DOI:10.3969/j.issn.1000-7377.2025.12.009]
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超声心动图冠状动脉Z值在川崎病患儿治疗前后的变化及其预测因素分析

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年12期
页码:
1641-1649
栏目:
临床研究
出版日期:
2025-12-05

文章信息/Info

Title:
Changes in echocardiographic coronary artery Z-scores before and after treatment in children with Kawasaki disease and its predictors
作者:
严晓华1; 张泰鸣2; 高娜1; 穆志龙1; 贺望1; 万萱1; 焦富勇1; 马娟3
（1.陕西省人民医院儿童病院，陕西 西安 710068；2.新疆医科大学儿科学院，新疆 乌鲁木齐 830054；3.陕西省人民医院检验科，陕西 西安 710068）
Author(s):
YAN Xiaohua1; ZHANG Taiming2; GAO Na1; MU Zhilong1; HE Wang1; WAN Xuan1; JIAO Fuyong1; MA Juan3
(1.Children’s Hospital,Shaanxi Provincial People’s Hospital,Xi’an 710068,China;2.College of Pediatrics,Xinjiang Medical University,Urumqi 830054,China;3.Department of Laboratory,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)
关键词:
川崎病; 超声心动图; 冠状动脉Z值; 诊断; 预后; 预测因素
Keywords:
Kawasaki disease; Echocardiography; Coronary artery Z-score; Diagnosis; Prognosis; Predictive factors
分类号:
R 725.4
DOI:
DOI:10.3969/j.issn.1000-7377.2025.12.009
文献标志码:
A
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。
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.

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备注/Memo:
陕西省中医药管理局科研课题（2021-01-ZZ-014）；陕西省中西医结合心血管病防治重点实验室开放课题（KF2224）；陕西省人民医院科技人才支持计划（拔尖人才）资助项目（2022BJ-08）
更新日期/Last Update: 2025-12-05