中国实用儿科杂志

中国实用儿科杂志

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经胸超声心动图和螺旋CT冠状动脉成像在川崎病冠状动脉病变随访中应用价值的比较

  

  1. 青岛大学附属妇女儿童医院 a心脏中心， b重症医学中心，山东  青岛  266034
  • 出版日期:2021-05-06 发布日期:2021-06-09

Comparison of the value of transthoracic echocardiography and spiral CT coronary angiography in the follow-up of coronary artery lesions of Kawasaki disease

  1. *Department of Heart Center，Women and Children’s Hospital，Qingdao University，Qingdao  266034，China  
  • Online:2021-05-06 Published:2021-06-09

摘要： 目的　比较经胸超声心动图（TTE）和螺旋CT冠状动脉成像（CTA）在川崎病（KD）患儿冠状动脉病变（CAL）随访中的价值。方法　回顾性分析青岛大学附属妇女儿童医院2017年6月至2020年1月收治的512例KD患儿的TTE和CTA资料。512例中29例于急性期TTE检查发现CAL而恢复期TTE显示冠状动脉正常，或急性期TTE检查冠状动脉正常但恢复期随访过程中TTE检查冠状动脉可疑异常，或多人次TTE检查冠状动脉测量结果不一致者，将其分为急性期合并CAL（急性期CAL）组以及急性期未合并CAL（急性期Non-CAL）组。所有患儿于恢复期行TTE和CTA检查，分析CAL好发部位、大小、数目和风险分级，比较TTE和CTA对KD患儿CAL的评估价值。结果　29例KD患儿恢复期TTE发现冠状动脉瘤/扩张数19支，CTA发现28支，其中急性期Non-CAL组TTE较CTA漏诊7支（P＜0.05），分别为左冠状动脉主干（LMCA） 4支，冠状动脉左回旋支（LCX） 3支；两种检查方法对急性期CAL组CAL风险分级评估差异无统计学意义（P＞0.05），但对急性期Non-CAL组CAL分级评估差异有统计学意义（P＜0.01），其中TTE评估9例为CAL Ⅰ级，而CTA评估仅4例为Ⅰ级，6例为Ⅲa级，其中1例为TTE冠状动脉无异常。TTE测量的29例KD患儿的LMCA Z值较CTA小（P＜0.01），而LAD Z值较CTA大（P＜0.05）；另外，急性期CAL组TTE显示分别有5例LMCA Z值和3例RCA Z值正常，但CTA均显示其Z值异常（P＜0.05）；急性期Non-CAL组TTE显示4例患儿LMCA Z值正常，而CTA显示其Z值异常（P＜0.05）。结论　对于急性期发生CAL但恢复期TTE检查正常或急性期未发现CAL而恢复期TTE疑似CAL者不宜单纯采用TTE评估CAL，而应给予CTA验证。

关键词: 川崎病, 冠状动脉病变, CT冠状动脉成像, 经胸超声心电图

Abstract: Objective　 To compare the value of transthoracic echocardiography（TTE） and spiral CT coronary angiography（CTA） in the follow-up of coronary artery lesions（CAL） of Kawasaki disease（KD）.  Methods　A total of 512 children with KD diagnosed in Women and Children’s Hospital of Qindao University from June 2017 to January 2020 were induded in the study，and the TTE and CTA data were retrospectively analyzed. Among them，29 children with KD were found CAL by TTE in the acute phase and TTE showed normal coronary arteries during the recovery phase，or the coronary arteries were normal by TTE in the acute phase but suspected coronary artery abnormalities were found by TTE or the results of repeated TTE examinations were inconsistent during follow-up. They were divided into two groups：acute CAL group and acute Non-CAL group. All children were examined by TTE and CTA during the recovery period. The location，size，number，and risk classification of CAL were recorded，and the value of TTE and CTA in evaluating CAL in children with KD was compared. Results　Totally 19 coronary aneurysms/dilations were found by TTE in 29 children with KD during the recovery period，while 28 coronary aneurysms/dilations were detected by CTA. Among them，the acute Non-CAL group had 7 missed diagnoses by TTE compared to CTA（P＜0.05），which were 4 LMCA and 3 LCX. There was no significant difference between the two methods in CAL risk classification evaluation in the acute CAL group，but a significant difference in the acute Non-CAL group was found（P＜0.01）. Among them，9 cases were CAL Ⅰ grade assessed by TTE，while 4 cases were CAL Ⅰ grade and 6 cases were Ⅲa grade by CTA，in which 1 case was with normal coronary arteries by TTE. The LMCA Z values of 29 children measured by TTE was lower than those by CTA（P＜0.01），while the LAD Z values were larger than those by CTA（P＜0.05）. There were 5 cases with normal LMCA Z values and 3 cases with normal RCA Z values by TTE in the acute CAL group，but they were found with abnormal Z values by CTA（P＜0.05）；4 cases with normal LMCA Z values by TTE in the acute Non-CAL group were shown，while abnormal Z values were shown by CTA（P＜0.05）. Conclusion　For KD children with CAL in acute phase but without CAL during recovery phase by TTE，or without CAL in acute phase but suspected with CAL during recovery phase by TTE，TTE should not be used alone to evaluate CAL of KD children，but it should be combined with CTA.

Key words: Kawasaki disease, coronary artery lesion, CT coronary angiography, transthoracic echocardiography