激素联合丙种球蛋白治疗川崎病的疗效及对冠状动脉的影响

目的:探讨川崎病(KD)患儿应用丙种球蛋白(IVIG)治疗的必要性及不同剂量IVIG、无反应型KD应用激素的疗效。方法:72例KD急性期患儿,均于起病10d内给予IVIG治疗,按治疗剂量不同及是否联合激素分为3组,A组(31例)用IVIG400mg/(kg·d),连续5d。B组(23例)用IVIG2g/(kg·d),单次静脉给药或1g/(kg·d),连用2d。C组为IVIG无反应组(18例),起病10d内给予IVIG2g/(kg·d)(单剂给药)无效,再次应用IVIG2g/(kg·d)无效,再予以甲基泼尼松龙治疗。观察3组疗效及冠状动脉受损情况。结果:在热退时间、住院时间方面,B组患儿均短于A组(P<0.05)。治疗前及热退1周,3组白细胞(WBC)、C反应蛋白的(CRP)组内治疗前后比较,差异均有统计学意义(P<0.05)。A组血沉(ESR)治疗前后比较,无明显差异(P>0.05),而B、C组组内治疗前后比较,差异有统计学意义(P<0.05)。急性期,在冠状动脉并发症方面,3组间比较无明显差异(P>0.05)。而治疗后1个月,A组发生冠状动脉病变(CAD)6例(19.4%)。其中5例为冠状动脉扩张,1例为冠...

Study of Effect on Glucocorticoid and Intravenous Immune Globulin on Treatment of Kawasaki disease and changes of Coronary Artery

Objective: To prove IVIG is necessary for treatment of KD, and evaluate effects of three modalities with IVIG and methylprednisolone for patients who had no reaction to IVIG on treatment of KD. Method: 72 KD cases were treated by three different therapies respectively and divided into three groups. Group A (31 children) were treated with IVIG(400mg&#8226;kg-1&#8226;d-1) for 5 days.Group B were treated with IVIG (2g&#8226;kg- 1&#8226;d-1) for 1 day or IVIG (1g&#8226;kg- 1&#8226;d-1) for 2 days, and group C were treated with methylprednisolone plus IVIG (4g&#8226;kg- 1&#8226;d-1) in twice. Effects of three therapies and dynamic changes of the internal diameter of coronary artery were reexamined after treatment. Results: ① The days to treatment of fever and spent for temperature returned to normal were less in group B than that in group A.②In recovering of WBC and CRP,three groups had significantly difference after therapy (P<0.05), comparing with its before. In recovering of ESR, group A had no difference after treatment, while group B and C had significantly difference after therapy (P<0.05), comparing with its before. ③In the acute stage, there has no difference in three groups of coronary artery dilatation. After treatment for 1 month, there are 6 children who had coronary artery disease in group A (8.3%), while 2 children in group B (2.7%) and 2 children in group C (2.7%). Morbidity of CAD in group B was less than group A (P<0.05) after therapy for 1 month. Conclusions: ①It suggest that IVIG might play an important role in the prevention of CAD during the early stage of KD. These results suggest that high dose of IVIG can prevent impairment of cardiovascular system effectively in patients with KD. ②In patients who had no reaction to IVIG, Methylprednisolone could not only reduce temperature, recovering of WBC, CRP and ESR, but also improve the dilatation of coronary artery and further reduce the risk of pathologic changes of coronary artery in KD.