目的 对评估川崎病（KD）合并冠状动脉病变的4种超声心动图方法进行分析,为临床实现早期精准评估提供依据。方法 以2017年12月至2020年7月于心内科住院治疗的KD合并冠状动脉病变患儿为研究对象,比较Kobayashi、Dallaire、Olivieri 3种冠状动脉Z值计算公式及国内1988年冠状动脉评估标准对KD冠状动脉异常的评估结果。结果 共纳入患儿94例,男59例、女35例,中位年龄18.1（7.3~31.7）月。4种冠状动脉病变评估方法对于右冠状动脉近段（pRCA）、左冠状动脉主干（LMCA）、左前降支（LAD）不同病变程度的评判差异均有统计学意义（P<0.01）。两两比较发现,Olivieri对于pRCA巨大冠状动脉瘤的检出率低于Dallaire;对于LMCA正常及仅扩张的评估中,Olivier方法的检出率高于其他3种方法,对于小型冠状动脉瘤,Olivier方法的检出率低于Kobayashi及国内1988年标准;对于LAD巨大冠状动脉瘤,Dallaire检出率高于Kobayashi和Olivieri方法,差异均有统计学意义（P<0.05）。Dallaire方法评估右冠状动脉（RCA）发现,仅测量pRCA将导致11.7%的患儿低估RCA病变的扩张程度,并有52.1% RCA中段（mRCA）、27.7%RCA远段（dRCA）病变被漏诊。在测量LAD中段的患儿中,仅依靠Z值评估LAD近段将漏诊30%的LAD中段异常患儿。结论 为减少KD初期冠状动脉病变的漏诊,基于超声心动图评估KD合并冠状动脉病变时,应尽可能对4支冠状动脉的不同节段全程测量。对于RCA的近端及中远段建议采用Dallaire方法评估;对LAD中段建议采用大于相邻血管内径1.5倍比值的方法评估。

Objective Four echocardiographic methods for assessing Kawasaki disease (KD) complicated with coronary artery abnormalities were analyzed to provide a basis for early accurate clinical assessment. Methods The KD children combined with coronary artery lesions who were hospitalized in the Department of Cardiology from December 2017 to July 2020 were selected as the study subjects. Three Z-value formulas (Kobayashi, Dallaire and Olivieri) and 1988 domestic standard were used to evaluate the coronary artery abnormalities caused by KD. Results A total of 94 patients (59 boys and 35 girls) were enrolled with a median age of 18.1 (7.3-31.7) months. There were statistically significant differences in the lesions degree evaluation of proximal right coronary artery (pRCA), left main coronary artery (LMCA) and left anterior descending artery (LAD) among the four coronary artery lesions assessment methods (P<0.01). The detection rate of large coronary aneurysms in pRCA by Olivieri method was significantly lower than that by Dallaire method (P<0.05). The detection rate of Olivier method was significantly higher than the other three methods in the evaluation of normal and only dilated LMCA (P<0.05). For small coronary aneurysms, the detection rate of Olivier method was significantly lower than Kobayashi method and domestic standard in 1988 (P<0.05). Dallaire's detection rate was significantly higher than Kobayashi's and Olivieri's for large coronary aneurysms of LAD (P<0.05). When evaluating the right coronary artery (RCA) using the Dallaire method, it was found that if the pRCA was measured alone, the extent of RCA lesion expansion in 11.7% of patients would be underestimate, as well as 52.1% of middle RCA lesions and 27.7% of distant RCA lesions would be missed. Among the children who measured the middle of LAD, 30% of the children with abnormal middle of LAD were missed by Z-value evaluation of the proximal LAD alone. Conclusions In order to reduce the misdiagnosis of coronary artery lesions at the early stage of KD, all the different segments of the 4 coronary arteries should be measured as much as possible by echocardiography. The proximal and distal segments of RCA should be evaluated by Dallaire method. The criterion of a dimension >1.5 times should be used for the middle of LAD. For the middle of LAD, a ratio greater than 1.5 times the diameter of the surrounding segments is recommended.