| Objective:To find the suitable calculation formula of coronary artery Z-scores of children in Southern Sichuan area through the collection and statistical analysis of data on internal diameter of coronary artery,height,weight and body surface area(BSA)from normal children in this area.Apply the formula to patients with Kawasaki Disease(KD)and compare with the diagnostic criteria of traditional coronary artery dilatation.Analyze the evaluation,feasibility and superiority of KD’s diagnosis on the application of Z-scores to coronary artery dilatation in patients with KD.To provide a reliable reference for the early clinical diagnosis and treatment in patients with KD.Methods:1.Groups of normal children:children who took the echocardiography for the examination of cardiac structure during the routine medical examination in our hospital from February 2013 to February 2015 were measured by the internal diameter of left and right coronary artery.Their height and weight were measured,and the BSA was calculated.Children were divided into 4 groups by the age from 1 month to 6 months,6 months to 12 months,1 year to 6 years,6 years to 14 years.Obtained the best regression model and established the regression formula through the regression analysis of coronary artery and each growth index in 4 groups.Calculation formula of coronary artery Z-scores in all groups were estimated according to original Z-scores formula.Mean score,correlation and regression coefficient and standard deviation of internal diameter of coronary artery in the same group were also calculated.2.Groups of children with KD:Cases of children with KD which were diagnosed by Department of Pediatrics of Affiliated Hospital of Luzhou Medical College from October 2012 to December 2014 were selected.The internal diameters of the their left and right coronary artery were measured with the help of echocardiography.Their height,weight and BSA were also measured.Children were divided into 4 groups by the age from 1 month to 6 months,6months to 12 months,1 years to 6 years,6 years to 14 years.Calculated Z-scores by new formula.If Z-scores is more than or equal to 2.5,then as a coronary artery dilatation.Summarized cases of coronary artery dilatation in each group and compared with detection rate of traditional diagnosis criteria.Results:1.384 cases of normal children in southern Sichuan area were included in the experiment.212 male cases,accounting for 55.21%.172 female cases,accounting for 44.79%.The age was from 0.08 to 14 years and the average age was 3.24±3.57 years.The height was from 45.7cm to 161.7cm and the average height was 88.13±27.72cm.The weight was from 3.4kg to 57.3Kg and the average weight was 13.86±8.90Kg.4 age groups showed that coronary artery diameter was closely related to BSA through the regression analysis.R2 of LCA,RCA and BSA in all groups was ①0.779,0.699;②0.835,0.838;③0.8444,0.7824;④0.9191,0.8976.Further analysis showed that quadratic curve equation of BSA had the best correlation with internal diameter of coronary artery,and R2 of LCA,RCA,BSA2 in all groups was:①0.7799,0.703;②0.8909,0.841;③0.8565,0.8051;④0.9261,0.8992.2.Through the conversion of quadratic curve equation of BSA,calculated the formula ’of coronary artery Z-scores in all groups:① 1 month to 6 months group Z(LCA)＝(X-(2.008BSA2+ 1.565BSA +0.906))/0.132 Z(RCA)＝(X-(4.279BSA2+ 0.250BSA +0.886))/0.134② 6 months to 12 months group Z(LCA)=(X-(39.211BSA2-25.044BSA+5.784))/0.145 Z(RCA)=(X-(9.715BSA2-2.682BSA+1.266))/0.150③ 1 year to 6 years group Z(LCA)=(X-(2.056BSA2-0.561BSA+ 1.936))/0.215 Z(RCA)=(X-(2.557BSA2-1.377BSA+1.999))/0.196④ 6 years to 14 years group Z(LCA)=(X-(-0.908BSA2+ 3.573BSA+0.133))/0.294 Z(RCA)=(X-(-0.462BSA2 + 2.769BSA+0.171))/0.3183.166 cases of patients with KD were included in KD groups.The age was from 0.21 to 14 years and the average age was 3.69±3.39 years.Among them,108 male cases,accounting for 65.00%;58 female cases,accounting for 35.00%.The ratio of male to female was 1.86 to 1.According to the traditional Japanese Ministry of health standards in 1984,39 cases of pediatric patients were diagnosed by coronary artery deviation,accounting for 23.49%in all patients(male for 27case,female for 12 cases).Through the calculation of Z-scores in 4 groups,cases of coronary artery deviation which diagnosed by Z-scores were more than diagnosis results of traditional standard.The difference in all groups was statistically significant by χ2 examination(P<0.05).Detection rate of those two methods had significant difference,and Z-scores was higher.Conclusion:1.There was the best relevance between quadratic curve equation of coronary artery deviation and BSA of normal children in southern Sichuan area.2.There was a high incidence with Kawasaki disease children in southern Sichuan area,special in infants and children under 4 years old.The ratio of male to female was 1.86 to 1.Coronary artery lesion in male also happened more frequently than in female.3.The diagnostic rate of KD could be significantly improved through calculation and evaluation of coronary artery lesion by New Z-scores after BSA correction in clinic application,which could help doctors diagnose and treat KD early,and avoid misdiagnosis,missed diagnosis or result in Serious complications of KD,especially incomplete KD. |
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