观察川崎病患儿颈动脉内膜-中层厚度（IMT）和踝肱指数（ABI），探究其与冠状动脉病变程度的相关性。

选取2018年2月至2019年10月于衢州市人民医院确诊为川崎病的患儿52例，根据心脏彩色多普勒超声检查结果将所有患儿分为未发生冠状动脉病变的对照组（29例）和发生冠状动脉病变的观察组（23例）。同时选取健康儿童25例为健康组。分析川崎病患儿发生冠状动脉病变的特征，测量所有儿童的颈动脉IMT、ABI以及冠状动脉内径，进行独立样本t检验分析和方差分析，采用Pearson相关分析法分析颈动脉IMT、ABI与冠状动脉病变程度的相关性，绘制受试者操作特征（ROC）曲线评估颈动脉IMT、ABI以及两者联合预测冠状动脉病变的效能。

23例观察组患儿中，仅发生冠脉扩张患儿21例（91.30%，21/23），发生冠状动脉瘤患儿2例（8.70%，2/23）；共有57支冠状动脉发生病变，3例（13.04%，3/23）患儿累及单支冠状动脉，8例（34.78%，8/23）累及2支冠状动脉，10例（43.48%，10/23）累及3支冠状动脉，2例（8.70%，2/23）累及4支冠状动脉。颈动脉IMT和冠状动脉内径观察组儿童均高于对照组和健康组儿童［IMT：（0.61±0.07） mm vs （0.42±0.02） mm vs （0.36±0.04） mm；冠状动脉内径：（3.17±0.18） mm vs （2.51±0.28） mm vs （2.13±0.31） mm］，差异均具有统计学意义（IMT：t=13.948，P＜0.001；t=15.348，P＜0.001；冠状动脉内径：t=9.802，P＜0.001；t=14.050，P＜0.001），对照组IMT和冠状动脉内径均高于健康组，差异具有统计学意义（t=7.118，P＜0.001；t=4.732，P＜0.001）；观察组ABI低于对照组和健康组儿童［（0.78±0.17） vs （0.89±0.12） vs （0.92±0.05）］，差异具有统计学意义（t=2.733，P=0.009；t=3.940，P＜0.001）。川崎病患儿颈动脉IMT与冠状动脉内径大小呈正相关（r=0.684，P＜0.001）；ABI与冠状动脉内径大小呈负相关（r=-0.692，P＜0.001）。ROC曲线分析显示，颈动脉IMT、ABI预测川崎病患儿冠状动脉病变的曲线下面积分别为0.628（95% CI：0.475~0.781）、0.649（95% CI：0.499~0.786），敏感度分别为60.9%、64.3%，特异度分别为79.4%、76.8%；颈动脉IMT、ABI联合诊断的曲线下面积为0.828（95% CI：0.716~0.940），当最佳截断值为0.706时，敏感度为81.2%，特异度为89.4%，高于颈动脉IMT、ABI单独预测（Z=6.731，P＜0.001；Z=6.492，P＜0.001）。

川崎病患儿颈动脉IMT以及ABI的变化与冠状动脉病变程度有一定相关性，并且颈动脉IMT和ABI的联合检测能够提高其预测冠状动脉病变的准确性，可以为预测川崎病患儿冠状动脉病变程度提供临床参考价值。

To measure the carotid intima-media thickness (IMT) and ankle brachial index (ABI) of 52 children with Kawasaki disease, and analyze their correlation with the severity of coronary artery lesions.

Fifty-two children with Kawasaki disease confirmed at People's Hospital of Quzhou were selected from February 2018 to October 2019. The children were divided into a control group (n=29) without coronary artery lesions or an observation group (n=23) with coronary artery lesions according to the results of color Doppler echocardiography. At the same time, 25 healthy children were selected as a healthy group Carotid IMT, ABI, and coronary artery diameter of all children were measured and analyzed by independent sample t-test and ANOVA. Pearson correlation was used to analyze the correlation of carotid IMT and ABI with the severity of coronary artery lesions. The receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of carotid IMT and ABI in predicting coronary artery lesions.

Among the 23 children in the observation group, 21 (91.30%, 21/23) had coronary artery dilatation and 2 (8.70%, 2/23) had coronary artery aneurysm. A total of 57 coronary arteries were involved, with 1, 2, 3, and 4 coronary arteries involved in 3 (13.04%, 3/23), 8 (34.78%, 8/23), 10 (43.48%, 10/23), and 2 children (8.70%, 2/23), respectively. The IMT of the carotid artery and the diameter of coronary artery in the observation group were significantly higher than those in the control group and the healthy group [IMT: (0.61±0.07) mm vs (0.42±0.02) mm and (0.36±0.04) mm, t=13.948 and 15.348, P＜0.001; diameter of coronary artery: (3.17±0.18) mm vs (2.51±0.28) mm and (2.13±0.31) mm, t=9.802 and 14.050, P＜0.001], and IMT and coronary artery diameter in the control group were significantly higher than those in the healthy group (t=7.118 and 4.732, P＜0.001). The ABI of the observation group was significantly lower than that of the control group and healthy group [(0.78±0.17) vs (0.89±0.12) and (0.92±0.05), t=2.733 and 3.940, P=0.009 and ＜0.001]. The carotid IMT in children with Kawasaki disease was positively correlated with the diameter of the coronary artery (r=0.684, P＜0.001), and ABI was negatively correlated with the diameter of the coronary artery (r=-0.692, P＜0.001). ROC curve analysis showed that the areas under curves (AUCs) of carotid IMT and ABI for predicting coronary artery lesions in children with Kawasaki disease were 0.628 (95% CI: 0.475~0.781) and 0.649 (95% CI: 0.499~0.786), respectively, with sensitivities of 60.9% and 64.3% and specificities of 79.4% and 76.8%, respectively. The AUC of combined carotid IMT and ABI was 0.828 (95% CI: 0.716~0.940). When the optimal cutoff value was 0.706, the sensitivity was 81.2% and the specificity was 89.4%. The AUC of combined carotid IMT and ABI was higher than that of either carotid IMT or ABI alone (Z=6.731, P＜0.001; Z=6.492, P＜0.001).

The changes of carotid IMT and ABI in children with Kawasaki disease have a certain correlation with the severity of coronary artery lesions, and the combined detection of carotid IMT and ABI can improve the accuracy of predicting coronary artery lesions, which provides a clinical reference for predicting the degree of coronary artery lesions in children with Kawasaki disease.