| Background: Kawasaki disease(KD)is an acute systemic vasculitis disease whose etiology is not yet clear.Coronary artery lesions(CAL),caused by specific involvement of coronary artery is a common cause of acquired heart disease in children.Echocardiography(ECHO)is the preferred method for evaluating coronary artery lesions in KD.The American Heart Association(AHA)2017 edition of "Diagnosis,Treatment,and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association" recommends that the standardized Z score of ECHO coronary artery corrected by body surface area(BSA)be used to quantitatively evaluate CAL,and be used as a basis for long-term cardiac risk assessment.However,the application of standardized Z score in our country has not been widely recognized.Objective: Echocardiographic standardized coronary artery Z score was used to quantitatively evaluate coronary artery lesions in children with Kawasaki disease during the past 11 years and during the epidemic period of coronavirus disease 2019(COVID-19)in this area,and to explore the clinical laws of CAL.Methods: This is a cross-sectional study,the original echocardiographic data of children with KD diagnosed and treated in our hospital from January 2009 to August 2020 were reviewed.The echocardiographic Z score regression model established based on BSA was used to calculate the maximum Z score of coronary artery.According to the grading standard of coronary artery lesions(CAL),the distribution of CAL in different years,months,sex and age,as well as the distribution characteristics of different clinical manifestations and response to IVIG treatment were compared.To compare the incidence and clinical distribution laws of coronary artery aneurysm(CAA)in KD during the epidemic period of COVID-19 and the same period in the past 11 years.Results: From January 2009 to December 2019,there were 3613 cases of clinically diagnosed KD,of which 2419 cases were included with complete data.The ratio of male to female is 1.8.The median age of children with KD was 21.3 months(11.6months,38.6months).The incidence of coronary artery aneurysms in males was larger than that in females(25.16% vs 15.92%,P < 0.05).The incidence rate of coronary artery aneurysms in children less than 6 months(36.44%)was higher than that in other age groups,and the Z score was the highest,and the coronary artery lesions was more serious(P < 0.001).The incidence rate of coronary artery aneurysms was higher in atypical kawasaki disease(32.74%)and IVIG resistance patients(30.45%)than in typical kawasaki disease(18.99%)and IVIG therapy-sensitive patients(20.60%)(P <0.001).During the outbreak of COVID-19(January-August 2020),there was no significant difference in the incidence of coronary artery aneurysms compared with the previous 11-year period(19.23% vs 20.98%,P =0.636).And,During the outbreak of COVID-19,KD was younger and the median age was 18 months vs 21.8 months,P < 0.05.The incidence rate of coronary artery aneurysms was as high as 41.51% in the 1-3 years old group.During the period of COVID-19,there was no significant difference in the ratio of coronary artery aneurysms between patients with atypical kawasaki disease and those who were resistant to IVIG therapy compared with the same epidemic period in the past 11 years,P > 0.05.Conclusion: The standardized Z score of echocardiography is used to quantify the degree of CAL,which objectively reflects the changes of CAL.It has good reliability and application value,and can provide a basis for the treatment of KD in acute stage and health management in convalescent stage.There was no significant change in the incidence of coronary artery aneurysms in patients with KD during the past 11 years and the epidemic period of COVID-19. |
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