氯吡格雷联合阿司匹林对川崎病并发中小型冠状动脉瘤患儿抗血栓治疗的疗效及安全性研究

目的 探讨川崎病（KD）合并冠状动脉瘤（CAA）患儿使用氯吡格雷联合阿司匹林抗血栓治疗的疗效及安全性。方法 选取2013年1月至2018年6月经超声心动图诊断为合并多发中小型CAA的KD患儿77例为研究对象，随机分为观察组（n=38）和对照组（n=39），分别接受氯吡格雷+阿司匹林和低分子肝素+阿司匹林治疗。所有患儿定期随访，以病程前3个月为观察期，总结两组患儿的冠状动脉变化及其他并发症发生情况。结果 随访至3个月时，观察组6例冠状动脉恢复正常，11例冠状动脉较前回缩，19例冠状动脉稳定，2例发展为巨大冠状动脉瘤；对照组7例冠状动脉恢复正常，12例冠状动脉较前回缩，19例冠状动脉稳定，1例发展为巨大冠状动脉瘤；两组冠状动脉变化情况比较差异无统计学意义（P > 0.05）。观察组合并鼻衄2例，皮肤瘀斑6例；对照组合并鼻衄1例，出现注射部位瘀点瘀斑7例；两组均未出现其他严重出血事件。结论 氯吡格雷联合小剂量阿司匹林对KD合并CAA患儿的抗血栓治疗安全有效。

Clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease complicated by small/medium-sized coronary artery aneurysms

Objective To study the clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease (KD) complicated by coronary artery aneurysm (CAA). Methods A total of 77 KD children who were diagnosed with multiple small/medium-sized CAAs by echocardiography between January 2013 and June 2018 were enrolled. They were randomly divided into observation group with 38 children (treated with clopidogrel and aspirin) and control group with 39 children (treated with low-molecular-weight heparin and aspirin). All children were followed up regularly, and the first 3 months of the course of the disease was the observation period. The children were observed in terms of the change of the coronary artery and the incidence of complications. Results At month 3 of follow-up, among the children in the observation group, 6 had normal coronary artery, 11 had coronary artery retraction, 19 had stable coronary artery, and 2 progressed to giant coronary aneurysm; among the children in the control group, 7 had normal coronary artery, 12 had coronary artery retraction, 19 had stable coronary artery, and 1 progressed to giant coronary aneurysm; there was no significant difference in the change of the coronary artery between the two groups (P > 0.05). There were 2 cases of epistaxis and 6 cases of skin ecchymosis in the observation group, and 1 case of epistaxis and 7 cases of petechiae and ecchymosis at the injection site in the control group, and no other serious bleeding events were observed in either group. Conclusions Clopidogrel combined with low-dose aspirin is safe and effective in antithrombotic therapy for children with KD complicated by CAA.