超声心动图对儿童川崎病早期诊断的作用探讨  

Effect of echocardiography for early diagnosis of children with Kawasaki disease

作　　者：夏焙[1] 李姝娜[1] 邱宝明[2] 陶宏伟[1] 袁雄伟[2] 李永柏[2] 李成荣[2] 

机构地区：[1]深圳市儿童医院超声科,518026 [2]深圳市儿童医院内科,518026

出　　处：《中华医学超声杂志（电子版）》2009年第5期34-38,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：深圳市科学技术项目基金(200304187)

摘　　要：目的探讨超声心动图(ECHO)在儿童川崎病(KD)早期诊断中的作用。方法回顾分析我院2000年1月至2005年11月417例儿童川崎病超声心动图表现,与167例发热待查患儿对比,评价超声心动图诊断儿童川崎病的敏感性、特异性、诊断优势比(DOR)。结果川崎病患儿冠状动脉扩张(41.00%)、管壁及管周异常回声(65.20%)、冠状动脉流速增加(77.93%)和室壁节段性运动异常(70.26%)均比发热待查患儿显著增高(P<0.005);川崎病二尖瓣反流(19.9%)和心包积液(4.8%)发病率也比发热待查高(P<0.05);但主动脉根部扩张两组没有差异(P>0.05)。超声心动图诊断儿童川崎病的敏感性、特异性、诊断优势比(95%CI)分别是:(1)冠状动脉瘤:4%、100%、16.0(0.02～9830.33);(2)冠状动脉扩张:41%、98%、39.0(3.00～560.05);(3)管壁及管周异常回声:65%、94%、30.0(6.00～120.36);(4)节段性室壁运动异常:70%、88%、17.0(5.00～53.84);(5)冠状动脉峰值流速增加:78%、73%、9.0(4.00～24.01);(6)二尖瓣反流:20%、92%、3.0(0.70～10.65);(7)主动脉根部扩张:4%、93%、0.6(0.11～3.40);(8)心包积液:5%、99%、4.0(0.15～116.42)。早期超声检查组302例(病程<10d)与延迟检查组115例(病程≥10d)比较,静脉注射丙种球蛋白较早,冠状动脉瘤的发生率明显减低(P<0.005)。结论冠状动脉瘤是儿童川崎病特征性表现;管壁及管周异常回声、节段性室壁运动异常、冠状动脉峰值流速增加和冠状动脉扩张可作为超声心动图早期诊断儿童川崎病的主要依据,超声心动图早期诊断川崎病对减少冠状动脉瘤的发生有重要临床意义。Objective To evaluate the effect of echocardiography on early diagnosis of children with Kawasaki disease（KD）. Methods We retrospectively studied standardized echocardiography results of 417 consecutive patients with KD and 167 patients with fever of unknown（FOU） in Shenzhen Children＇s Hospital between January 2000 and November 2005. The sensibility, specificity, diagnostic odds ratio （DOR） and 95% CI were analysed. Results Compared with FOU patients, coronary distension（41.0%）or aneurysm （4.1%） ,coronary arterial wall and periarterial prominence echo （65.20%）, coronary flow rate increase （77.93%） and ventricle segment motion abnormality （70.26%） were higher in KD patients （P〈0.005） , mitral regurgitation（19.9%） and pericardial fluid（4.8%） were higher in KD patients than in FOU patients （P〈0.05） as well, but aortic root distension （4.3 %, P 〉 0.05）. The sensibility, specificity, DOR （95% CI） of ECHO in patients with KD were respectively 4%, 100%, 16.0（0.02-9830.33）in coronary aneurysm, 41% ,98% ,39.0（3.00-506.05） in coronary distension, 65% ,94% ,30.0（6.00-120.36） in coronary arte- rial wall and periartefial prominence echo, 70%, 88% , 17.0（ 5.00-53.84 ） in ventricle segment motion abnormality, 78% ,73% ,9.0（4.00-24.01） in coronary flow rate increase, 20% ,92% ,3.0（0.70-10.65） in mitral regurgitation, 4%, 93%, 0.6 （0.11-3.40） in aortic root distension and 5%, 99%, 4.0（0.15-116.42） in pericardial fluid. Compared with patients with early ECHO （ 〈 10 d） , the rate of coronary aneurysms was higher in patients with delayed ECHO（ ≥10d, P〈0.005）. Conclusions Coronary aneurysm is the characteristic feature of ECHO for diagnose of KD. The other features of ECHO such as coronary arterial wall and periarterial prominence echo,ventricle segment motion abnormality, coronary flow rate increase and coronary distension can be principal references for diagnose of KD. Echocardiograpby is significant for early diagnosis of

关 键 词：多普勒超声心动描记术 黏膜皮肤淋巴结综合征 儿童 

分 类 号：R725.4[医药卫生—儿科]