甲基泼尼松龙治疗IVIG无反应型川崎病的效果评价

目的观察甲基泼尼松龙治疗静脉注射丙种球蛋白(IVIG)无反应型川崎病(KD)的临床疗效及对实验室相关指标的影响。方法选择在本院治疗的IVIG无反应型KD患儿60例,将其按随机数字表法分为两组,各30例。对照组接受IVIG再次冲击治疗;于对照组基础上,观察组加甲基泼尼松龙治疗。观察两组临床疗效、实验室相关指标[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、冠脉损伤发生率及不良反应。结果观察组有效率为90.00%,高于对照组的66.67%,(χ^(2)=4.812,P<0.05);治疗前两组TNF-α、IL-6水平及冠脉损伤率对比差异无统计学意义(t=0.049、0.032,χ^(2)=0.067,P值均>0.05);治疗后观察组TNF-α为(9.80±3.73)ng/L、IL-6为(19.72±6.29)ng/L,均低于对照组的(13.97±4.21)ng/L、(32.85±7.48)ng/L,(t=5.397、9.781,P值均<0.05)、治疗后观察组冠脉损伤率为3.33%,低于对照组的23.33%,(χ^(2)=3.606,P<0.05)。观察组、对照组不良反应发生率分别为10.00%、6.67%,差异无统计学意义(χ^(2)=0.000,P值>0.05)。结论IVIG无反应型KD患儿接受甲基泼尼松龙治疗有利于提升治疗效果且安全,利于减少冠脉损伤,改善炎症反应。

Effect evaluation of methylprednisolone in treatment of IVIG unresponsive Kawasaki disease

Objective To observe the clinical efficacy of methylprednisolone in the treatment of intravenous immunoglobulin (IVIG) (gamma globulin) unresponsive Kawasaki disease (KD) and its influence on laboratory related indexes. Methods A total of 60 children with IVIG unresponsive KD were randomly divided into a control group and an observation group with 30 cases in each group. The control group was treated with IVIG again; on the basis of the control group, the observation group was treated with methylprednisolone. The clinical efficacy, laboratory related indexes , incidence of coronary artery injury and adverse reactions were observed. Results The effective rate of the observation group (90.00%) was higher than that of the control group (66.67%) (χ2=4.812, P<0.05); before the treatment, there was no significant difference in the levels of TNF-α, IL-6 and coronary artery injury rate between the two groups (t=0.049, 0.032, χ2=0.067, P>0.05); after the treatment, the levels of TNF-α and IL-6 in the observation group were (9.80±3.73) ng/L and (19.72±6.29) ng/L, respectively, and the coronary artery injury rate was 3.33%, which were lower than those in the control group . The incidence of adverse reactions in the observation group and the control group were 10.00% and 6.67% respectively, and the difference was not statistically significant (χ2=0.000, P>0.05). Conclusion Methylprednisolone treatment in the children with IVIG nonresponsive KD can improve the therapeutic effect and safety, reduce coronary artery injury and improve inflammatory response.