| Objective:Echocardiography is the main method to diagnose coronary artery disease in Patients with Kawasaki disease.The diameter of the coronary artery is the key to assess the degree of coronary artery disease.In the Past,the internal diameter of the coronary artery was directly measured to evaluate the degree of coronary artery dilation.This quantitative method was affected by a variety of factors including changes in race,height,weight,and body surface area.In order to avoid the influence of these factors on the inner diameter of the coronary arteries,domestic and foreign studies have standardized the Z value to define the changes in the inner diameter of the coronary arteries.At present there are 5 kinds of Z-value formula calculation methods commonly used in China,including Japanese and American Z-value calculation methods from abroad,and Shenzhen,Jilin,and Sichuan calculation methods from domestic countries.Five Z-value formula calculation methods(hereinafter referred to as Z-value methods))Calculate the Z value of the coronary artery diameter,compare the diagnosis of Kawasaki disease with coronary lesions,determine the difference and efficacy of different Z-value methods in the diagnosis of Kawasaki disease with coronary artery lesions,and Provide some evidence-based evidence for its clinical diagnosis.in accordance with.Method:Subjects:A retrospective analysis of children aged 0-14 who were diagnosed with"Kawasaki disease" in the First Affiliated Hospital of Xiamen University from January 2017 to December 2019.Method:Collect the height,weight gender,age,and diameter of the coronary arteries in the children(including the left coronary artery,the left anterior descending coronary artery,the left coronary circumflex branch,and the right coronary artery)Coronary artery branch inner diameter).The collected internal diameter of the coronary artery was diagnosed according to the traditional coronary artery disease diagnosis method(hereinafter referred to as traditional method)and five types of Z-value calculation formulas commonly used in domestic hospitals.Standards,comparing the specificity,sensitivity,and difference of the detection rates of coronary lesions in 6 methods.Result:1.A total of 189 cases from January 2017 to December 2019 that met the Kawasaki disease criteria and had sound clinical data were collected from the First Affiliated Hospital of Xiamen University).2.Diagnosing Kawasaki disease with coronary artery damage using traditional methods and various Z-value calculation methods.The results are as follows:155/189(82.01%)Patients with normal coronary artery disease and 34/189 Patients with coronary artery disease(17.99%);129/189(68.25%)of normal coronary arteries diagnosed by US Z-value method;60/189(31.75%)of coronary artery lesions diagnosed by Japanese Z-value method(144.189 cases of 76)%),45/189 cases(23.81%)of coronary artery damage;157/189 cases(83.07%)of normal coronary artery diagnosis by Shenzhen Z value method,32/189 cases(16.93%)of coronary artery damage;Sichuan Z value Methods Diagnose 123/189 Patients with normal coronary arteries(65.08%);66/189 Patients with coronary artery damage(34.92%);Jilin Z-value method diagnosed 125/189 Patients with normal coronary arteries(66.14%);64/189 cases(33.86%).3.Diagnosing the diagnosis of KD combined with CAL using 5 types of Z-value methods and traditional methods.The results show that the Sichuan Z-value method has the highest diagnosis rate(34.92%)and the traditional method has the lowest(17.99%);Sichuan Z-value method and American Z value The diagnostic rate of KD combined with CAL by Jilin Z-value method was also significantly higher than that of traditional methods(P<0.05).The Japanese Z-value method and Shenzhen Z-value method had no significant difference in the diagnostic rate of KD with CAL compared with traditional methods(P>0.05).4.Using the US Z-value method as the standard the remaining 4 types of Z-value formula diagnosis results were analyzed statistically.The results showed that the Japanese Z-value method(χ2=2.967α,P=0.085)and the Sichuan Z-value method(χ2=0.429α,P=0.513),Jilin Z-value method(χ2=0.192α,P=0.661)and the US Z-value method have no significant difference in diagnosis rate;the domestic Shenzhen Z-value method has a significantly lower diagnostic rate than the US Z-value method(χ2=11.263α,P=0.001).In terms of diagnostic sensitivity,Jilin Z-value method>Japanese Z-value method>Sichuan Z-value method>Shenzhen Z-value method;in terms of diagnostic specificity,Shenzhen Z-value method>Japan Z-value method>Jilin Z-value method>Sichuan Z Value method.Conclusion:1.6 methods including 5 Z-value methods and traditional methods have different diagnostic rates for KD combined CAL;Sichuan Z-value method,Jilin Z-value method,and US Z-value method have higher diagnostic rates than traditional methods;5 Z-value methods Among the three methods,the Japanese Z-value method,the Sichuan Z-value method,and the Jilin Z-value method,compared with the US Z-value method,there was no difference in the diagnosis rate of Kawasaki disease with coronary lesions;Compared with the method,the diagnosis rate is significantly lower.In addition to the US Z-value method,the sensitivity and specificity of the four Z-value methods also differ.Comparing 2.5 Z-value methods,there are differences in diagnostic efficiency.The highest sensitivity is the Jilin Z-value method,and the highest specificity is the Shenzhen Z-value method At Present there is a lack of a unified Z-value calculation form,ula which needs to consider the influence of race,region and other factors,and further large-scale clinical data research is needed.Objective:Coronary damage is a key factor in determining the Prognosis of Kawasaki disease.At Present,there is no unified conclusion on the results of Kawasaki disease(KD)combined with coronary artery disease(CAL)high-risk factors.The incidence of Kawasaki disease is related to innate immunity,and the current studies have not analyzed the effects of different ages on Kawasaki disease with coronary artery damage.This study grouped children with diffferent age and maturity in Peripheral blood lymphocyte subgroups in Chinese children,and analyzed whether there are differences in laboratory indicators of children with Kawasaki disease and coronary artery abnormalities at different ages.And help.Method:Subjects:A retrospective analysis of children aged 0-14 who were diagnosed with Kawasaki disease at the First Affiliated Hospital of Xiamen University from January 2017 to December 2019.Research methods:Collect the results of cardiac color Doppler ultrasound in children,and determine the normal coronary artery group and coronary artery damage group based on the coronary artery internal diameter Z value.The first Part collects general clinical data of children in the acute Phase(months of age m,height cm,weight kg,fever days d,length of hospital stay d),clinical manifestations(rash,cervical lymph nodes,bulbar conjunctival hyperemia,lip congestion,cleft Palate,bayberry tongue,Peeling of swollen hands and feet,Perianal Peeling,and the involvement of each system),analysis of all age groups,and comparison of the results of children with coronary lesions and those with normal coronary arteries;The second Part retrospectively collected laboratory test results of children with KD(WBC,NEUT,PLR,NLR,PLT,HGB,D-dimer,FDP,FIB,ALT,AST,ALB,CK-MB,BNP,CTN1,CRP,PCT,IL-6,FER,ESR,C3,C4,IgA,IgG,IgM,CD3,CD4,CD4/CD8,CD19,CD56),refer to Chinese children’s Peripheral blood lymphocyte subgroup maturity Children were divided into 0-6 months(≤6 months),June-1 years(>6 months,≤1 year),and 1-4 years(>1 years,≤4 years).In the 4-8-year-old group(greater than 4 years old,≤8 years old),the laboratory indicators of children with Kawasaki disease and coronary artery abnormalities at different ages were analyzed for differences.According to the distribution of data,the measurement data were analyzed by independent sample T test or rank sum test,and the count data were analyzed by chi-square test The differences in the expressions of general clinical data and laboratory test results between the 2 groups of children and the same age group were analyzed.Results:1.A total of 189 children were collected,including 60 children(31.75%)in the coronary artery damage group and 129 children(68.25%)in the normal coronary group.2.According to univariate analysis of all age groups,combined with bone and joint system involvement(P<0.05),no cervical lymphadenopathy(P<0.05),mitral valve combined with tricuspid regurgitation combined with left atrial ventricle during cardiac ultrasound Increase(P<0.05),white blood cell count(WBC)is greater than 8.86 × 1012/L(P<0.05,Az= 0.596),albumin(ALB)is less than 17.7g/L(P<0.05.Az=0.398).asparagus Transaminase(AST)greater than 15.5(P<0.05,Az=0.395)was a risk factor for KD combined with CAL.Logistic regression analysis found that the duration of fever was greater than 7.5 days(P<0.05,area under the ROC curve Az=0.638),and the length of hospital stay was longer than 7.5 days(P<0.05,Az=0.633)were independent risk factors for KD combined with CAL.3.According to the univariate analysis grouped by age of immunization,blood urea and NLR increased in children with KD combined with CAL in 0-6 months(both P<0.05);IgA decreased in children with KD combined with CAL aged 1-4 years And CD3 increased(both P<0.05).Conclusion:1.Children with KD and CAL are more likely to be affected by bone and joint system involvement,and are less likely to have cervical lymphadenopathy,increase leukocytes,decrease albumin,and increase aspartate aminotransferase.After age grouping,it was found that increased blood urea and NLR in children with KD in the 0-6-month group were risk factors for combined CAL;decreased IgA and increased CD3 in the 1-4-year-old group were risk factors for combined CAL.2.Fever duration>7.5 days and hospital stay>7.5 days were independent risk factors for KD with CAL. |
