The Mystery of the Z-Score.
The Mystery of the Z-Score.
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DOI：
10.12945/j.aorta.2016.16.014
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发表时间：
2016-08-01
期刊：
影响因子：
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通讯作者：
Elefteriades, John A
中科院分区：
文献类型：
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作者：
Curtis, Alexander E;Smith, Tanya A;Elefteriades, John A
测量胸主动脉的可靠方法对于确定动脉瘤疾病的治疗策略至关重要。 Z 分数是成人医学中常用的原始直径尺寸的实用替代方案。它们对于身体发育快速变化的儿科人群尤其有价值。 Z 分数的优点是它包含体表面积 (BSA)，以确定主动脉是否在正常尺寸限制内。因此，Z 分数使我们能够确定是否存在真正的病理学，这对于成长中的儿童来说可能具有挑战性。此外，Z 分数可以对不同性别、种族和地理区域的主动脉大小进行深思熟虑的解释。尽管使用 Z 分数有很多优点，但也有其局限性。其中包括观察者内部和观察者之间的偏差、测量误差以及替代 Z 分数列线图和 BSA 方程之间的变化。此外，尚不清楚正常人群的 Z 分数如何随时间变化，这在解释序列值时至关重要。美国超声心动图协会儿科和先天性心脏病委员会制定了测量主动脉参数的指南，这可能会减少计算主动脉根部 Z 分数时的测量偏差。此外，还开发了基于网络的 Z 分数计算器，以帮助进行高效的 Z 分数计算。尽管取得了这些进步，临床医生必须注意 Z 分数的局限性，特别是在用于证明有益的治疗效果时。这篇评论旨在揭开 Z 分数的神秘面纱，重点关注胸主动脉。在这里，我们将讨论 Z 分数的计算方式及其使用的局限性。
Reliable methods for measuring the thoracic aorta are critical for determining treatment strategies in aneurysmal disease. Z-scores are a pragmatic alternative to raw diameter sizes commonly used in adult medicine. They are particularly valuable in the pediatric population, who undergo rapid changes in physical development. The advantage of the Z-score is its inclusion of body surface area (BSA) in determining whether an aorta is within normal size limits. Therefore, Z-scores allow us to determine whether true pathology exists, which can be challenging in growing children. In addition, Z-scores allow for thoughtful interpretation of aortic size in different genders, ethnicities, and geographical regions. Despite the advantages of using Z-scores, there are limitations. These include intra- and inter-observer bias, measurement error, and variations between alternative Z-score nomograms and BSA equations. Furthermore, it is unclear how Z-scores change in the normal population over time, which is essential when interpreting serial values. Guidelines for measuring aortic parameters have been developed by the American Society of Echocardiography Pediatric and Congenital Heart Disease Council, which may reduce measurement bias when calculating Z-scores for the aortic root. In addition, web-based Z-score calculators have been developed to aid in efficient Z-score calculations. Despite these advances, clinicians must be mindful of the limitations of Z-scores, especially when used to demonstrate beneficial treatment effect. This review looks to unravel the mystery of the Z-score, with a focus on the thoracic aorta. Here, we will discuss how Z-scores are calculated and the limitations of their use.