不同剂量丙种球蛋白治疗小儿川崎病的临床疗效

目的探讨不同剂量丙种球蛋白治疗小儿川崎病的临床疗效及安全性。方法本研究将收集2012年1月—2016年12月住院的川崎病患儿按照数字表法随机分为对照组和治疗组,2组患儿均服用阿司匹林作为基础治疗,其中对照组给予丙种球蛋白1 g/(kg·d)静脉输注,使用1～2 d(若热不退用2 d);研究组给予丙种球蛋白2 g/(kg·d)静脉输注,使用1 d。比较2组患者的临床治疗效果及不良反应发生情况。结果研究组患儿的退热时间较对照组明显缩短,且差异具有统计学意义(t=5.853,P<0.05);而2组患儿的黏膜充血、颈部淋巴结肿大及手足肿胀消退时间比较差异无统计学意义(t=1.418、1.552、0.719,均P>0.05)。2组患儿治疗后白细胞计数(WBC)、C反应蛋白(CRP)、血沉(ESR)及血小板计数(PLT)等实验室指标均较治疗前明显改善(均P<0.05);治疗后2组间上述实验室指标比较差异无统计学意义(均P>0.05)。治疗后,研究组有7例发生冠状动脉病变,对照组有13例发生冠状动脉病变,研究组患儿治疗后冠状动脉病发生率(14.00%)明显低于对照组(26.00%),且差异具有统计学意义(χ~2=4.089,P=0.043)。研究组有1例患儿在静滴丙种球蛋白后出现不良反应,表现为畏寒、恶心,减慢静脉滴注速度后缓解并最终消失,所有患儿未发生其他不良反应。结论对于川崎病,丙种球蛋白2 g/(kg·d)的治疗效果明显优于1 g/(kg·d),且并发症少,发生冠状动脉病变率低,安全性高。

Clinical efficacy of different doses of intravenous immunoglobulin in the treatment of children with Kawasaki disease

Objective To investigate the clinical efficacy and safety of different doses of intravenous immunoglobulin in the treatment of children with Kawasaki disease. Methods The children with Kawasaki disease admitted from January 2012 to December 2016 were randomly divided into control group and study group according to the digital table method. The two groups were both treated with aspirin as the basic treatment. The control group was given intravenous immunoglobulin 1 g/(kg·d) for 1-2 days (2 days in case of continuous high temperature). While the study group was given twice doses. The clinical efficacy and the adverse reactions of the two groups were compared. Results The fever reducing time in the study group was significantly shorter than that in the control group (t=5.853, P<0.05), but there was no significant difference in the regression time of mucosal blood transfusion, cervical lymph node swelling and hand-foot swelling between the two groups (t=1.418, 1.552, 0.719, all P>0.05). After the treatment, WBC, CRP, ESR, PLT and other laboratory indicators in the two groups were significantly improved compared with their own group before treatment (all P<0.05), but there was no significant difference between the two groups after treatment (all P>0.05). There were 7 cases of coronary artery disease in the study group and 13 cases of coronary artery disease in the control group after treatment. Statistical analysis showed that the incidence of coronary artery disease in the study group (14.00%) was significantly lower than that in the control group (26.00%) and the difference was statistically significant (χ2=4.089, P=0.043). One of the children in the study group had adverse reactions such as chills and nausea after injecting intravenous immunoglobulin. The symptoms were relieved and disappeared after decreasing the intravenous drip speed. In addition, there were no other obvious adverse reactions in the two groups. Conclusion The therapeutic effect of intravenous immunoglobulin 2 g/(kg·d) dose is significantly better than 1 g/(kg·d) dose in treating Kawasaki disease with fewer complications, low incidence of coronary artery disease and high safety, which is worthy of clinical promotion.