川崎病患儿不同时期血小板变化在药物治疗策略上的意义

目的:探讨血小板在川崎病(KD)患儿急性期及恢复期变化的临床意义。方法:回顾性收集我院2016年的KD住院患儿临床资料,探讨急性期血小板变化与静脉丙种球蛋白(IVIG)治疗无反应KD及冠状动脉病变(CAL)之间的关系,以及在恢复期对小剂量阿司匹林应用的指导意义。结果:本研究共纳入808例KD患儿。IVIG治疗无反应组36例(4.46%),IVIG治疗有反应组772例(95.54%)。IVIG治疗无反应组患儿的血小板计数(PLT)、血小板压积(PCT)低于IVIG治疗有反应组,血小板平均体积(MPV)高于IVIG治疗有反应组(P均<0.05)。恢复期有CAL(CAL组)178例(22.03%),恢复期无CAL(n CAL组)630例(77.97%)。规律随访并服用小剂量阿司匹林的恢复期n CAL患儿420例,服药6周后321例(76.43%)PLT可降至400×10^9/L以下,8周为355例(84.52%),差异有统计学意义(χ^2=8.76,P<0.05);12周为371例(88.33%),与8周时比较差异无统计学意义(χ^2=2.60,P>0.05)。结论:PLT、PCT、MPV急性期变化可能与IVIG治疗无反应相关,与CAL无明显关系。对无CAL或一过性冠脉扩张的绝大多数KD患儿,口服小剂量阿司匹林疗程在6~8周适宜。

Significance of Changes of Platelet in Children with Kawasaki Disease during Different Period in Clinical Therapy Strategies

[Abstract] Objective: To probe into the clinical significance of changes of platelet (PLT) in children with Kawasaki disease (KD) during acute and recovery period. Methods: Clinical data of hospitalized children with KD in our hospital in 2016 were retrospectively collected to investigate the relationship between changes of platelet during acute period and non-responsive intravenous gamma globulin (IVIG) treatment of KD and coronary artery disease (CAL), the guiding significance on the application of low-dose aspirin during recovery period was analyzed. Results: A total of 808 children with KD were collected. There were 36 cases (4.46%) in non-responsive IVIG group and 772 cases (95.54%) in responsive IVIG group. The PLT count and platelet hematocrit (PCT) of children in non-responsive IVIG group were lower than those in responsive IVIG group, and the mean platelet volume (MPV) was higher than that in responsive IVIG group (P<0.05). There were 178 cases (22.03%) with CAL (CAL group) and 630 cases (77.97%) without CAL (nCAL group) during recovery period. Totally 420 cases in nCAL group took low-dose aspirin regularly were followed up. PLT count in 321 cases (76.43%) was lower than 400×109/L after 6 weeks, 355 cases (84.52%) was lower than 400×109/L after 8 weeks, the difference was statistically significant (c2=8.76, P<0.05). PLT count in 371 cases (88.33%) was lower than 400×109/L after 12 weeks, compared with 8 weeks, the difference was not statistically significant (c2=2.60, P>0.05). Conclusion: Changes of PLT, PCT, and MPV during acute period may be related to non-responsive IVIG treatment, and have no significant relationship with CAL. For the majority of children with KD and without CAL or transient coronary dilatation, 6 to 8 weeks of oral low-dose aspirin treatment is appropriate.